Endoscopy 2003; 35(7): 559-563
DOI: 10.1055/s-2003-40240
Original Article
© Georg Thieme Verlag Stuttgart · New York

Value of Chromoendoscopy and Magnification Endoscopy in the Evaluation of Duodenal Abnormalities: a Prospective, Randomized Comparison

R.  Kiesslich 1 , K.  Mergener 2 , C.  Naumann 1 , M.  Hahn 3 , M.  Jung 4 , H.  H.  Koehler 5 , B.  Nafe 1 , S.  Kanzler 1 , P.  R.  Galle 1
  • 1 Dept. of Medicine I, Johannes Gutenberg University, Mainz, Germany
  • 2 Section of Gastroenterology, Virginia-Mason Medical Center, Seattle, Washington, USA
  • 3 Division of Gastroenterology, Beverly Hospital, Beverly, Massachusetts, USA
  • 4 Dept. of Internal Medicine, St. Hildegardis Hospital, Mainz, Germany
  • 5 Institute of Pathology, Johannes Gutenberg University, Mainz, Germany
Further Information

Publication History

Submitted 8 August 2002

Accepted after Revision 25 February 2003

Publication Date:
24 June 2003 (online)

Background and Study Aims: Endoscopic staining methods are increasingly being used to evaluate lesions in the esophagus and colon. The aim of this prospective study was to investigate chromoendoscopy and magnification endoscopy for the evaluation of mucosal lesions in the duodenum.
Patients and Methods: Consecutive patients were randomly assigned to undergo conventional endoscopy without staining (group A) or intravital staining of the duodenal mucosa with indigo carmine and evaluation with a conventional video endoscope (group B) or a magnification endoscope (group C). Visible lesions were characterized before and after staining, and biopsies were taken for histological assessment.
Results: A total of 118 patients was examined. Chromoendoscopy detected significantly more lesions in the duodenal bulb (98 vs. 28; P = 0.0042) in more patients (29 vs. 15; P = 0.0025) compared with conventional endoscopy (group A). After mucosal staining, there was no difference between video endoscopy and magnification endoscopy with regard to the number or extent of the lesions identified. Significantly more targeted biopsies were possible after intravital staining. The most commonly identified lesions on targeted biopsies included (staining/control groups): gastric metaplasia (14/3), hyperplastic Brunner’s glands (6/3), inflammatory changes (7/6), villous atrophy (1/3), adenoma (1/0).
Conclusions: Intravital staining of the duodenum with indigo carmine may be useful for detecting mucosal abnormalities, delineating their extent, and allowing targeted biopsies. Magnification endoscopy, when used in addition to chromoendoscopy, does not appear to further increase the diagnostic yield for detecting duodenal abnormalities.

References

  • 1 Rembacken B J, Fujii T, Cairns A. et al . Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK.  Lancet. 2000;  8 1211-1214
  • 2 Kudo S, Kashida H, Tamura T. et al . Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer.  World J Surg. 2000;  24 1081-1090
  • 3 Kudo S, Tamura S, Nakajima T. et al . Diagnosis of colorectal tumorous lesions by magnifying endoscopy.  Gastrointest Endosc. 1996;  44 8-14
  • 4 Kiesslich R, von Bergh M, Hahn M. et al . Chromoendoscopy with indigo carmine improves the detection of adenomatous and nonadenomatous lesions in the colon.  Endoscopy. 2001;  33 1001-1006
  • 5 Siegel L M, Stevens P D, Lightdale C J. et al . Combined magnification endoscopy with chromoendoscopy in the evaluation of patients with suspected malabsorption.  Gastrointest Endosc. 1997;  46 226-230
  • 6 Dixon M F, Genta R M, Yardley J H. et al . Classification and grading of gastritis: the updated Sydney System.  Am J Surg Pathol. 1996;  20 1161-1181
  • 7 Jepsen J M, Persson M, Jakobsen N O. et al . Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy.  Scand J Gastroenterol. 1994;  29 483-487
  • 8 Kadmon M, Tandara A, Herfarth C. Duodenal adenomatosis in familial adenomatous polyposis coli: a review of the literature and results from the Heidelberg polyposis register.  Int J Colorectal Dis. 2001;  16 63-75
  • 9 Kashiwagi H, Spigelmann A D. Gastroduodenal lesions in familial adenomatous polyposis.  Surg Today. 2000;  30 675-682
  • 10 Kohli Y, Nakayama N, Kawai K. Endoscopic and histological studies on vital staining of duodenal mucosa.  Endoscopy. 1974;  6 105-110
  • 11 Jung M, Kiesslich R. Chromoendoscopy and intravital staining techniques.  Baillière’s Best Pract Res Clin Gastroenterol. 1999;  13 11-19
  • 12 Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum.  Gastroenterology. 2001;  120 636-651
  • 13 Ravelli A M, Tobanelli P, Minelli L. et al . Endoscopic features of celiac disease in children.  Gastrointest Endosc. 2001;  54 736-742
  • 14 Chang C C, Pan S, Lien G S. et al . Relationship of duodenal ulcer recurrence to gastric metaplasia of the duodenal mucosa and duodenal bulb deformity.  J Formos Med Assoc. 2001;  100 304-308
  • 15 Chang C C, Pan S, Lien G S. et al . Investigation of the extent of gastric metaplasia in the duodenal bulb by using methylene blue staining.  J Gastroenterol Hepatol. 2001;  16 729-733
  • 16 Jonnsson K A, Gotthard R, Bodemar G, Brodin U. The clinical relevance of endoscopic and histologic inflammation of gastroduodenal mucosa in dyspepsia of unknown origin.  Scand J Gastroenterol. 1989;  24 385-395
  • 17 Urakami Y, Sano T. Endoscopic duodenitis, gastric metaplasia and Helicobacter pylori.  J Gastroenterol Hepatol. 2001;  16 513-518

R. Kiesslich, M. D.

I. Med. Klinik und Poliklinik

Johannes-Gutenberg-Universität Mainz · Langenbeckstrasse 1 · 55101 Mainz · Germany

Fax: + 49-6131-175552

Email: info@ralf-kiesslich.de