Chromoendoscopy Indigo Carmine Uses of Vital Stains

Indigo Carmine

Principle

Indigo carmine is not absorbed. It is a bluish dye that fills interstices and folds in the mucosa, highlighting surface irregularities and lesions and making them easier to distinguish from their surroundings (Fig. 4.62).

Technique

► Irrigate the area with water to remove mucus.

► Spray with a 0.1-1 % solution of indigo carmine.

► Inspect the area endoscopically and take selective biopsies.

Indications

► Identification of early gastric carcinoma

► Detection of villous atrophy in the duodenum in celiac disease

► Identification and delineation of mucosal lesions in the esophagus

■ Possible Uses of Vital Stains in the Upper Gastrointestinal Tract

Esophagus

► Squamous cell carcinoma. Possible indications are:

- Screening high-risk patients (e.g., with preexisting squamous cell carcinoma of the head or neck, achalasia, or corrosive ingestion)

- Accurately defining the extent of known early carcinoma prior to endoscopic mucosectomy

► Method of choice: Lugol solution

► Adenocarcinoma. Possible indications are:

- Suspected Barrett epithelium in reflux disease

- Surveillance of known Barrett epithelium to identify pre-malignant, dysplastic, or early malignant areas

► Method of choice: methylene blue staining

Stomach

► Adenocarcinoma. Possible indications are:

- Screening patients with a high cancer risk (e.g., pernicious anemia, previous partial gastrectomy, etc.)

► Method of choice: indigo carmine

Fig. 4.62 Indigo carmine dye a Polypoid lesions in the distal esophagus, before indigo carmine b Spraying the area with indigo carmine heightens the contrast between the lesions and their surroundings c Retroflexed view shows good distal delineation with indigo carmine

Fig. 4.62 Indigo carmine dye a Polypoid lesions in the distal esophagus, before indigo carmine b Spraying the area with indigo carmine heightens the contrast between the lesions and their surroundings c Retroflexed view shows good distal delineation with indigo carmine

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