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DOI: 10.1055/a-2213-1316
A syringe method for esophageal Lugol’s iodine chromoendoscopy
Gefördert durch: The Key Research and Development Program of Shaanxi Province Program No.2023-ZDLSF-36
Lugol’s iodine chromoendoscopy is the method commonly used to detect and diagnose esophageal squamous cell carcinoma [1] [2]. The conventional method of spraying iodine requires iodine solution diluted from the stock solution, a spraying catheter, and cooperation between the endoscopist and the assistant. Here, we report a novel syringe method for iodine spraying without the above requirements.
Before chromoendoscopy, a 20-ml syringe was employed to draw 3 ml of 5% iodine stock solution and 17 ml of air. When staining, the iodine was quickly expelled into the esophagus through the endoscope’s working channel at 20 cm from the incisors ([Fig. 1]). An iodine mist was created from the rapid spurt of the iodine solution and air, which prompts even distribution of the iodine solution on the esophageal wall ([Fig. 2] a,b). The lower segments of the esophageal wall were stained with the remaining iodine solution in the working channel by repeatedly spraying the air/iodine mixture using the syringe, resulting in consistent and uniform staining of the whole esophagus ([Video 1]).
Qualität:
The spraying method is safe and effective. Although the iodine mist was created during the chromoendoscopy, the direction of the iodine spray is from the proximal to the distal esophagus and uses only 3 ml of iodine solution. Therefore, theoretically, the incidence rate of coughing/irritation to the larynx caused by the reflux of iodine solution is very low. Our center has used the syringe method in over 100 cases; only one patient experienced coughing. Compared to the conventional method, the syringe method has the following advantages: a single individual method eliminating the need for an assistant; cost-saving with no need for a spraying catheter [3]; no need to dilute the iodine solution; and reduced flow of iodine into the stomach, which may potentially minimize mucosal injury.
Endoscopy_UCTN_Code_TTT_1AO_2AM
E-Videosis an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
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Publikationsverlauf
Artikel online veröffentlicht:
21. Dezember 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Liu M, Zhou R, Guo C. et al. Size of Lugol-unstained lesions as a predictor for risk of progression in premalignant lesions of the esophagus. Gastrointest Endosc 2021; 93: 1065-1073.e3
- 2 Guo Q, Fan X, Zhu S. et al. Comparing N-acetylcysteine with sodium thiosulfate for relieving symptoms caused by Lugol’s iodine chromoendoscopy: a randomized, double-blind trial. Gastrointest Endosc 2022; 95: 249-257
- 3 Gotoda T, Kanzaki H, Okamoto Y. et al. Tolerability and efficacy of the concentration of iodine solution during esophageal chromoendoscopy: a double-blind randomized controlled trial. Gastrointest Endosc 2020; 91: 763-770