Indigocarmine added to the water exchange method enhances adenoma detection - a RCT

Abstract

Purpose: Chromoendoscopy with dye spray and the water method both increase adenoma detection.

Hypothesis: Adding indigocarmine to the water method will enhance further the effectiveness of the latter in adenoma detection.

Methods: Screening colonoscopy was performed with the water method (control) or with 0.008% indigocarmine added (study) by two endoscopists. Randomization was based on computer-generated codes contained in blocks of pre-arranged opaque sealed envelopes. High resolution colonoscopes were used. Upon insertion into the rectum, air was suctioned. With the air pump turned off, water was infused using a blunt needle adaptor connected to the scope channel and a foot pump to facilitate scope insertion until the cecum was reached. Residual stool causing cloudiness was suctioned followed by infusion of clear or colored water (water exchange) to facilitate scope passage with minimal distention of the colonic lumen. Upon seeing the appendix opening under water, water was suctioned and air was insufflated to facilitate inspection on scope withdrawal.

Statistics: Sample size calculation revealed 168 patients (84/group) needed to be randomized. Study was IRB-approved and registered (NCT01383265).

Results: There were no significant differences in mean age, gender distribution, BMI, and family history of colon cancer. Cecal intubation success rate was 100% in both groups. The overall adenoma detection rate was 44% (water only) versus 62% (water with indigocarmine), respectively (p=0.03). One cancer was detected in each group.

Conclusion: In a RCT, indigocarmine at 0.008% concentration, added to the water method, significantly enhanced further the effectiveness of the latter in detecting adenomas.

Keywords: adenoma detection; colon cancer screening; indigocarmine; water method.

Figures

Figure 1

Polyp seen with water method. A: Flat polyp (adenoma) in proximal colon; B: NBI view of same polyp.

Figure 2

Polyps seen with water method. A: Small cecal polyp; B: Sessile polyp in ascending colon.

Figure 3

Polyp seen with dye plus water method. A: Polyp seen under blue (indigocarmine) water; B: Large flat adenoma in proximal colon; C: Small polyp in ascending colon. Note the bluish color fluid filling the surface irregularities and outline of the polyps.