The Efficacy of Pan‐Indigo Carmine Chromoendoscopy by Water‐Jet Pump in the Detection of Colorectal Lesions: A Randomized Controlled Trial

BACKGROUND: Pump-based chromoendoscopy is recommended for the surveillance of dysplasia associated with inflammatory bowel disease. This study was designed to compare the efficacy of pump-based pan chromoendoscopy (PCE) with white-light endoscopy (WLE) for the detection of colorectal neoplasia in patients at high risk of colorectal cancer (CRC). METHOD: This randomized controlled trial prospectively recruited 366 participants who were randomly allocated in a 1:1 ratio to the WLE group and the PCE group. PRIMARY OUTCOME: adenoma detection rate (ADR); secondary outcome: mean number of adenomas per procedure (MAP), sessile serrated lesion detection rate (SDR), flat adenoma detection rate (FDR), and advanced adenoma detection rate (AADR). RESULT: The ADR was significantly higher with PCE (86/167, 51.5%) versus WLE (57/165, 34.5%; RR 1.49 [95% 1.15 to 1.93]: p = 0.002). The FDR and SDR were significantly higher in PCE than in WLE (50.3% vs. 32.1% RR 1.57 [95% 1.20 to 2.05] p = 0.001; 10.8% vs. 2.4% RR 4.45 [95% CI 1.54 to 12.86] p = 0.002). CONCLUSIONS: This study demonstrated that using a novel spraying technique with low-concentration indigo carmine during colonoscopy achieved a significantly higher detection rate for colorectal lesions. Moreover, PCE significantly increased ADR, particularly for flat adenomas and the detection rate of sessile serrated lesions. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06596317.