High-resolution chromoendoscopy for the diagnosis of diminutive colon polyps: Implications for colon cancer screening

Background and Aims: A visual, nonbiopsy technique that could reliably determine the histology of diminutive colorectal polyps could greatly reduce the cost of colon cancer screening. This study was designed to report our experience using a high-resolution colonoscope combined with indigo carmine dye to diagnose diminutive colorectal polyps. Methods: Colonoscopy using a Fujinon EC-400 HM/HL was performed in 36 patients with polyps <10 mm in diameter. Polyps from the first 12 patients (phase 1) were sprayed with 10 mL of 0.2% indigo carmine dye, and a biopsy was performed or a specimen removed and submitted for histological analysis. The morphological data were used to predict polyp histology in the subsequent 24 patients (phase 2). Results: Hyperplastic polyps had a characteristic surface 'pit pattern' of orderly arranged 'dots' that resembled the surrounding, nonpolypoid mucosa. Adenomatous polyps had surface 'grooves' or 'sulci.' Sensitivity and specificity of our techniques in distinguishing adenomatous from nonadenomatous colorectal polyps were 93% and 95%, respectively. Conclusions: High-resolution chromoendoscopy provides morphological detail of diminutive colorectal polyps that correlates well with polyp histology. If incorporated into colon cancer screening, these techniques may limit the need for biopsy and/or subsequent colonoscopy and ultimately decrease costs.