Chromoendoscopy and its alternatives for colonoscopy: useful in the United States?

American endoscopists have essentially ignored chromoendoscopy (dye spraying) in the colon and overwhelmingly perform white-light colonoscopy only. The published studies suggest that routine use of chromoendoscopy in Western populations will lead to identification of additional flat lesions. However, a number of these studies have design flaws. The authors' interpretation of the existing data is that pancolonic chromoendoscopy to detect flat and depressed lesions is not yet proven as a useful and therefore necessary adjunct to routine colonoscopic examination in non-inflammatory bowel disease patients in the United States. Chromoendoscopy, particularly combined with magnification, is very effective in delineating the pit pattern of polyps and in allowing real-time differentiation of adenomatous from non-adenomatous lesions. There might be a role for chromo endoscopy with high magnification in the delineation of unresected portions of lateral spreading tumors being removed by piecemeal polypectomy and in the evaluation of polypectomy scars during endoscopic follow-up. The authors suggest that US endoscopists begin to familiarize themselves with shape classification, and that they learn a method to determine histology in real time.