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Value of chromoendoscopy and magnification endoscopy in the evaluation of duodenal abnormalities: a prospective, randomized comparison.

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.