Chromoscopy in the diagnosis and management of Barrett's esophagus

Chromoscopy broadly refers to the use of contrast agents to accentuate surface topography (contrast staining), and/or identify specific epithelia by vital staining (absorptive staining), or chemical reactions (reactive staining). Both contrast staining and absorptive staining technique have potential applications in patients with Barrett's esophagus. Accentuation of the detail of the surface topography of Barrett's esophagus with contrast staining may allow for identification of areas of Barrett's esophagus not appreciated during routine endoscopy or surface imperfections in areas of neoplasia that were missed by standard video endoscopic examination. Similarly, vital staining could be used to identify specific epithelia, ie, intestinal metaplasia or dysplasia that are associated with the carcinogenic pathway in Barrett's esophagus, or conversely identifying areas unstained that may represent early malignancy. Unfortunately, there is little data regarding the use of chromoendoscopy in Barrett's esophagus, and further work in this field is justified.