RSS-Feed abonnieren
DOI: 10.1055/s-1999-46
Staining in Gastrointestinal Endoscopy: Clinical Application and Limitations
Publikationsverlauf
Publikationsdatum:
31. Dezember 1999 (online)
![](https://www.thieme-connect.de/media/endoscopy/199906/lookinside/thumbnails/10.1055-s-1999-46-1.jpg)
Introduction
The fine detail of the structure of the gastrointestinal mucosa is not delineated during conventional endoscopy. Yamakawa et al. [1] reported in 1966 that spraying a blue dye solution over gastric mucosa was useful in revealing such structures as the areae gastricae. However, the results with this method were not always satisfactory, because gastric mucosa was also colored by the dye. In 1972 Ida et al. [2] reported a new procedure for eliminating gastric mucus. Using these techniques, the results of dye-spraying are consistently effective.
Chromoscopy is a recently coined term which denotes the use of colored materials to enhance the accuracy of endoscopic examination. Many different stains have been described for use, singly or in combination, prior to or during endoscopy. In gastrointestinal endoscopy dyes or stains have primarily been utilized to enhance the detection of diseased areas, to guide endoscopic biopsies, and to obtain better visual diagnosis or characterization of small abnormalities. Tattooing is a means of permanently labeling a site in the gastrointestinal tract for future identification by intramural injection of a pigment.
In recent years there has been a natural progression to the combined use of chromoscopy and high resolution video endoscopy and magnification endoscopy [3]. A variety of dyes, stains, and pigments have been utilized in gastrointestinal endoscopy. The classification of stains used for endoscopic purposes differs from that used in histochemistry. Contrast staining, sometimes termed chromoscopy, highlights tissue topography by entering mucosal depressions and crevices. Absorptive, or vital stains identify specific epithelial types or cellular constituents by preferential staining. Reactive stains identify cellular products, for example by the color change of a pH indicator (Table [1]).
References
-
1 Yamakawa K, Naito S, Kanai J.
Superficial staining of gastric lesions by fiberscopy. Proceedings of the first Congress of the International Society of Endoscopy. Tokyo; 1966: 586-590 - 2 Ida K, Misaki J, Kohli Y, Kawai K. Fundamental studies on the dye scattering method for endoscopy. Jpn J Gastroenterol Endosc. 1972; 14 261-266
- 3 Kudo S, Tamura S, Nakajima T, et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. 1996; 44 8-14
- 4 Meyer V, Burtin P, Bour B, et al. Endoscopic detection of early esophageal cancer in a high-risk population: does Lugol staining improve videoendoscopy?. Gastrointest Endosc. 1997; 45 480-484
- 5 Misumi A, Harada K, Murakmi A, et al. Role of Lugol dye endoscopy in diagnosis of early esophageal cancer. Endoscopy. 1990; 22 12-16
- 6 Nabeya K, Hanaoka T, Onozawa T, et al. Early diagnosis of esophageal cancer. Hepatogastroenterology. 1990; 37 368-370
- 7 Shiozaki H, Tahara H, Kobayashi K, et al. Endoscopic screening of early esophageal cancer with the Lugol dye method in patients with head and neck cancers. Cancer. 1990; 66 2068-2071
- 8 Chisholm E M, Williams S R, Leung J W, et al. Lugol's iodine dye-enhanced endoscopy in patients with cancer of the oesophagus and head and neck. Eur J Surg Oncol. 1992; 16 550-552
- 9 Ban S, Toyonaga A, Harada H, et al. Iodine staining for early endoscopic detection of esophageal cancer in alcoholics. Endoscopy. 1998; 30 253-257
- 10 Dawsey S M, Fleischer D E, Wang G Q, et al. Mucosal iodine staining improves endoscopic visualization of squamous dysplasia and squamous cell carcinoma of the esophagus in Linxian, China. Cancer. 1998; 83 220-231
- 11 Stevens P D, Lightdale C J, Green P HR, et al. Combined magnification endoscopy with chromoendoscopy for the evaluation of Barrett's esophagus. Gastrointest Endosc. 1994; 40 747-749
- 12 Niveloni S, Fiorini A, Dezi R, et al. Usefulness of video-duodenoscopy and vital dye staining as indicators of mucosal atrophy of celiac disease: assessment of interobserver agreement. Gastrointest Endosc. 1998; 47 223-229
- 13 Canto M I, Setrakian S, Petras R E, et al. Methylene blue selectively stains intestinal metaplasia in Barrett's esophagus. Gastrointest Endosc. 1996; 44 1-7
- 14 Mashberg A, Samit A M. Early detection, diagnosis, and management of oral and oropharyngeal cancer. CA Cancer J Clin. 1989; 39 67-88
- 15 Hix W R, Wilson W R. Toluidine blue staining of the esophagus: a useful adjunct in the panendoscopic evaluation of patients with squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 1987; 113 864-865
- 16 Seitz J F, Monges G, Navarro P, et al. Endoscopic detection of dysplasia and early esophageal cancer: results of a prospective study with toluidine blue vital staining in 100 tobacco and alcohol abusers. Gastroenterol Clin Biol. 1990; 14 15-21
- 17 Contini S, Consigii G F, Di Lecce F, et al. Vital staining of oesophagus in patients with head and neck cancer: still a worthwhile procedure. Ital J Gastroenterol. 1991; 23 5-8
-
18 Cartier R.
Practical colposcopy. Basel; Karger 1997 - 19 Cartier R. The role of colposcopy in the diagnosis and treatment of dysplasias and intra-epithelial carcinomas of the uterine cervix. Bull Cancer. 1979; 66 447-454
- 20 Guelrud M, Herrera I. Acetic acid improves identification of remnant islands of Barrett's epithelium after endoscopic therapy. Gastrointest Endosc. 1998; 47 512-515
- 21 Ida K, Hashimoto Y, Takeda S, et al. Endoscopic diagnosis of gastric cancer with dye scattering. Am J Gastroenterol. 1975; 63 316-320
- 22 Ida K, Kohli Y, Shimamoto K, Kawai K. Endoscopic findings of fundic and pylori gland area using dye scattering method. Endoscopy. 1973; 5 21-26
-
23 Okuda S, Saegusa T, Ito T, et al.
An endoscopic method to investigate the gastric acid secretion. Proceedings of the First Congress of the International Society of Endoscopy. Tokyo; Hitachi Printing 1966: 221-226 - 24 Tatsuta M, Okuda S, Taniguchi H, Tamura H. Gross and histological types of early gastric carcinomas in relation to the acid-secreting area. Cancer. 1979; 43 317-321
- 25 Tatsuta M, Iishi H, Okuda S, Taniguchi H. Diagnosis of early gastric cancers in the upper part of the stomach by the endoscopic congo red-methylene blue test. Endoscopy. 1984; 16 131-134
- 26 Iishi H, Tatsuta M, Okuda S. Diagnosis of simultaneous multiple gastric cancers by the endoscopic congo red-methylene blue test. Endoscopy. 1988; 20 78-82
- 27 Donahue P E, Bombeck T, Yoshida J, Nyhus L M. The simplified endoscopic congo red test for completeness of vagotomy. Surg Gynecol Obstet. 1986; 163 287-289
- 28 Papiela T, Turczynowski W, Karcx D, et al. Long-term results of highly selective vagotomy in the treatment of duodenal ulcer patients using the intra-operative endoscopic congo red test to identify the parietal cell antrum-corpus borderline. Hepatogastroenterology. 1993; 40 267-271
- 29 Bowden T A. endoscopic testing for completeness of vagotomy: red or black but not yet black or white. Gastrointest Endosc. 1987; 33 458-459
- 30 Donahue P H, Bombeck C T, Yoshida Y, Nyhus L M. Endoscopic Congo red test during proximal gastric vagotomy. Am J Surg. 1987; 153 249-255
- 31 Fennerty M B, Sampliner R E, McGee D L, et al. Intestinal metaplasia of the stomach. Identification by a selective mucosal staining technique. Gastrointest Endosc. 1992; 38 696-698
- 32 Tatsuta M, Lishi H, Ichii M, et al. Chromoendoscopic observations on extension and development of fundal gastritis and intestinal metaplasia. Gastroenterology. 1985; 88 70-74
- 33 Kim C Y, Fleischer D E. Colonic chromoscopy. A new perspective on polyps and flat adenomas. Gastrointest Endosc Clin N Am. 1997; 7 423-437
- 34 Mitooka H, Fujimori T, Maeda S, et al. Colon polyp detected by contrast chromoscopy using indigo carmine capsule. Dig Endosc. 1992; 4 350-354
- 35 George L L, Van Stolk R U, Brzezinski A, et al. Evaluation of indigo carmine dye spray as a diagnostic tool in assessing diminutive polyps found at screening sigmoidoscopy (abstract). Gastrointest Endosc. 1994; 40 93
- 36 Axelrad A M, Fleischer D E, Geller A J, et al. High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: implications for colon cancer screening. Gastroenterology. 1996; 110 1253-1258
- 37 Adachi M, Muto T, Okinaga K, Morioka Y. Clinicopathologic features of the flat adenoma. Dis Colon Rectum. 1991; 34 981-986
- 38 Kuramoto S, Ihara O, Sakai S, et al. Depressed adenoma in the large intestine: endoscopic features. Dis Colon Rectum. 1990; 33 108-112
- 39 Jaramillo E, Watanabe M, Befrits R, et al. Small, flat colorectal neoplasis in long-standing ulcerative colitis detected by high-resolution electronic video endoscopy. Gastrointest Endosc. 1996; 44 15-22
- 40 Karita M, Cantero D, Okita K. Endoscopic diagnosis and resection treatment for flat adenoma with severe dysplasia. Am J Gastroenterol. 1993; 88 1421-1423
- 41 Mitooka H, Shirakawa K, Naka Y, et al. Differentiation of diminutive neoplastic polyps from non-neoplastic polyps by the pit patterns observed by magnifying colonoscope (abstract). Gastrointest Endosc. 1994; 40 95
- 42 Muto T, Kamiya J, Sawada T, et al. Small “flat adenoma”of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum. 1985; 28 847-851
- 43 Matsumoto T, Iida M, Kuwano Y, et al. Minute non-polypoid adenoma of the colon detected by colonoscopy: correlation between endoscopic and histologic findings. Gastrointest Endosc. 1992; 38 645-650
- 44 Riddell R H. Flat adenomas and carcinomas: seeking the insivisible?. Gastrointest Endosc. 1992; 38 721-723
- 45 Mion F, Desseigne F, Napoleon B, et al. Failure of endoscopic detection of a de novo carcinoma of the colon in a patient with adenomatous polyps. Gastrointest Endosc. 1992; 38 703-706
- 46 Bond J H. Small flat adenomas appear to have little clinical importance in Western countries. Gastrointest Endosc. 1995; 42 184-187
- 47 Tedesco F J, Hendrix J H, Pickens C A, et al. Diminutive poylps: histopathology, spatial distribution, and clinical significance. Gastrointest Endosc. 1982; 28 1-5
- 48 Waye J D, Lewis B S, Frankel A, Geller S A. Small colon polyps. Am J Gastroenterol. 1988; 83 120-122
- 49 Mitooka H, Fujimori T, Maeda S, Nagasako K. Minute flat depressed neoplastic lesions of the colon detected by contrast chromoscopy using an indigo carmine capsule. Gastrointest Endosc. 1995; 41 453-459
- 50 Kudo S, Tamura S, Nakajima T, et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. 1996; 44 8-14
- 51 Kim J O, Lee Y H, Shim C S, et al. The usefulness of pit patterns of colorectal tumors and magnifying colonoscopy. Kor J Gastrointest Endosc. 1998; 18 324-330
- 52 Yokota T, Sugano K, Kondo H, et al. Detection of aberrant crypt foci by magnifying colonoscopy. Gastrointest Endosc. 1997; 46 61-65
- 53 Mizuno M, Matsumoto T, Iida M, et al. Magnifying colonoscopic features in non-neoplastic polyps of the colorectum. Gastrointest Endosc. 1997; 46 537-541
- 54 Matsumoto T, Kuroki F, Mizuno M, et al. Application of magnifying chromoscopy for the assessment of severity in patients with mild to moderate ulcerative colitis. Gastrointest Endosc. 1997; 46 400-405
- 55 Jaramillo E, Watanabe M, Slezak P, Rubio C. Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy. Gastrointest Endosc. 1995; 42 114-122
- 56 Ono K, Watanaka N, Kumaguya T, et al. Staining of local lymph nodes by submucosal injection of a dye in the periphery of gastric and rectal cancer. Stomach Intestine. 1966; 1 975-979
- 57 Waldman D, Oehlert W. The intramural injection of indian ink - a useful method for preoperative marking of the gastrointestinal wall. Endoscopy. 1978; 10 141-145
- 58 Rosch W. Contribution of gastroscopy to early diagnosis and treatment of gastric carcinoma. J Cancer Res Clin Oncol. 1979; 93 1-6
- 59 Hammond D C, Lane F R, Mackeigan J M, Passinault W J. Endoscopic tattooing of the colon: clinical experience. Am Surg. 1993; 59 205-210
- 60 Ponsky I L, King J F. Endoscopic marking of colonic lesions. Gastrointest Endosc. 1975; 22 42-43
- 61 Hyman N, Waye J D. Endoscopic four quadrant tattoo for the identification of colonic lesions at surgery. Gastrointest Endosc. 1991; 37 56-58
- 62 Shatz B A, Thavorides V. Colonic tattoo for follow-up of endoscopic sessile polypectomy. Gastrointest Endosc. 1991; 37 59-60
- 63 Fennerty M B, Sampliner R E, Hixson L J, Garewal H. Effectiveness of India ink as a long-term colonic mucosal marker. Am J Gastroenterol. 1992; 87 79-81
- 64 Salomon P, Berner J S, Waye J D. Endoscopic India ink injection: a method for preparation, sterilization, and administration. Gastrointest Endosc. 1993; 39 803-805
- 65 Tanaka M. Usefulness of dye endoscopy and its problems in the diagnosis of minute mucosal abnormalities. Gastroenterol Endosc. 1990; 2 303-312
- 66 Ng T Y, Datta T D, Kirimli B I. Reaction to indigo carmine. J Urol. 1976; 116 132-133
- 67 Naitoh J, Fox B M. Severe hypotension, bronchospasm, and urticaria from intravenous indigo carmine. Urology. 1994; 44 271-272
- 68 Coman E, Brandt L J, Brenner S, et al. Fat necrosis and inflammatory pseudotumor due to endoscopic tattooing of the colon with India ink. Gastrointest Endosc. 1991; 37 65-68
- 69 Park S I, Genta R S, Romero D P, Weesner R E. Colonic abscess and focal peritonitis secondary to India ink tattooing of the colon. Gastrointest Endosc. 1991; 37 68-71
- 70 Horning D, Kuhn J, Stadelmann O, et al. Phlegmonous gastritis after India ink marking. Endoscopy. 1983; 15 266-269
- 71 Lightdale C J. India ink colonic tattoo: blots on the record. Gastrointest Endosc. 1991; 37 99-100
- 72 Sills M R, Zinkham W H. Methylene blue-induced Heinz body hemolytic anemia. Arch Pediatr Adolesc Med. 1994; 148 306-310
C. S. ShimM.D.
Institute for Digestive Research
Soon Chun Hyang University Hospital
657 Hannam-Dong, Yongsan-Ku
Seoul 140-743
South Korea
Telefon: + 82-2-7491968
eMail: schidr@hosp.sch.ac.kr