Staining in Gastrointestinal Endoscopy: Clinical Application and Limitations

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]).

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