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Coloration vitale du tractus gastro-intestinal

Vital staining in the gastrointestinal tract

  • Techniques Endoscopiques Endoscopic Techniques
  • Published:
Acta Endoscopica

Résumé

Au cours des dernières années, les méthodes de coloration ont pris de plus en plus d’importance en endoscopie digestive. Le but de l’endoscopie diagnostique est de visualiser les structures épithéliales et de détecter les altérations de la muqueuse normale. Le pronostic défavorable de l’évolution des tumeurs gastro-intestinales requiert une détection précoce des anomalies des muqueuses et des méthodes de thérapie locale. Les vidéo-endoscopes modernes à haute résolution permettent de visualiser de façon remarquable les fins détails de l’épithélium. Cette visualisation de la surface épithéliale peut encore être améliorée par une coloration complémentaire. Les termes de «colorations vitales» et de «chromoendoscopie» sont synonymes. En combinant la technique avec les progrès instrumentaux et le développement des endoscopes grossissants, la chromoendoscopie a acquis une importance considérable.

La solution au Lugol permet une reconnaissance et une démarcation optimales de la dysplasie et du carcinome au début dans la zone des cellules épidermoïdes de l’œsophage. Le bleu de méthylène colore sélectivement la métaplasie intestinale de l’œsophage de Barrett. Selon des essais récents, la différenciation des zones de dysplasie localisées dans une métaplasie intestinale peut aussi être rendue possible grâce à la coloration par le bleu de méthylène. L’application de l’indigo carmin améliore la détection du cancer gastrique au début et est en même temps utile avant résection endoscopique locale. Les colorations du duodénum par l’indigo carmin ou par le bleu de méthylène sont particulièrement utiles à la mise en évidence d’une atrophie muquese partielle. La coloration vitale du côlon par l’indigo carmin et par le crésyl violet parfois utilisé comme coloration supplémentaire, permet une analyse détaillée des très petites lésions coliques, en particulier de type plat et/ou déprimé, ainsi que la prédiction de leur évolution histologique. La chromoendoscopie selon la classification des puits est particulièrement importante avant de prendre une décision thérapeutique (résection muqueuse endoscopique, exérèse chirurgicale).

La chromoendoscopie, technique simple, bon marché, et rapide, est largement utilisée en endoscopie gastro-intestinale. Des études complémentaires au sujet de l’équipement technique, du protocole de coloration et de la variation inter-observateurs seront nécessaires pour permettre à la chromoendoscopie de devenir un procédé diagnostique standard en endoscopie de routine.

Summary

In the last years staining methods became more and more important in endoscopy of the gastrointestinal tract. The aim of diagnostic endoscopy is to make epithelial structures visible and to detect alterations of normal mucosa. The poor prognosis of progressive gastrointestinal tumors requires an early detection of mucosal abnormalities and methods for local therapy. Using modern high-resolution videoendoscopy remarkable improvements in the visualization of fine epithelial details have been made possible. Enhancement of the epithelial surface can be achieved by additional staining. Vital staining and chromoendoscopy are synonymous for the same techniques. In combination with technical progress, the development of magnifying endoscopes, chromoendoscopy gains a considerable importance.

Lugol-solution leads to an optimized recognition and demarcation of dysplasia and early carcinoma in the squamous cell part of the esophagus. Methylene blue selectively stains the intestinal metaplasia in Barrett’s esophagus. According to recent trials also differentiation of dysplastic areas within intestinal metaplasia may be possible by methylene blue staining. The application of indigo carmine improves the detection of early gastric cancer and in the meantime it is necessary before local endoscopical resection. Staining the duodenum with either indigo carmine or methylene blue is especially beneficial for visualizing partial mucosal atrophy. Vital staining in the colon with indigo carmine and optional dying with cresyl violet enables the detailed analysis of minute colon lesions, especially flat and/or depressed type, and the prediction of their histological outcome. Chromoendoscopy is remarkably important before further decisions concerning the therapy according to the pit pattern classification (endoscopic mucosal resection, surgical removal).

Chromoendoscopy as a technically simple, cheap and not very time-consuming method is increasingly accepted in gastrointestinal endoscopy. Further studies concerning for example technical equipment, staining protocol and inter-observer variation will be required to establish chromoendoscopy as a standard diagnostic procedure in routine endoscopy.

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  1. Internal Medicine/Gastroenterology, St. Hildegardis-Krankenhaus, Academic Teaching Hospital of Johannes, Gutenberg-University, Mainz, Germany

    W. Weber, Carla Ohlerth & M. Jung

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Weber, W., Ohlerth, C. & Jung, M. Coloration vitale du tractus gastro-intestinal. Acta Endosc 32, 763–777 (2002). https://doi.org/10.1007/BF03028481

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