1% Lugol’s Iodine Solution Should Be Used for Esophageal Chromoendoscopy
Prateek Sharma, MD, FASGE reviewing Gotoda T, et al. Gastrointest Endosc 2019 Oct 25.
Lugol’s iodine has been utilized for dye-spray chromoendoscopy to detect esophageal squamous cell carcinoma and/or dysplasia. The main goals are to reveal subtle lesions in the esophagus and to delineate the borders of visible lesions. This helps both for early diagnosis and in the endoscopic treatment (either mucosal resection or submucosal dissection) of these lesions. However, the iodine solution can cause mucosal irritation, leading to chest pain and discomfort and, uncommonly, to esophagitis, gastric ulcerations, and perforation. These side effects of iodine are attributed to its concentration level. In clinical practice, the usual iodine concentration that is used ranges from 1% to 3%.
In this single-center, randomized, double-blind study, eligible patients undergoing chromoendoscopy were randomly assigned to either 1% or 2% iodine concentration dye for spraying in the esophagus. The primary endpoint of this study was the difference in the pain measurement between the 2 groups (using a scale of 0-5). The secondary endpoints were detection of esophageal neoplasia, safety, and color evaluation (rated by independent endoscopists) for each group. Sixty-four patients were included in the final analysis, with 35 patients receiving 1% iodine spray and 29 patients receiving 2% iodine spray. The heartburn and retrosternal pain scores were significantly lower in those who underwent 1% spray versus those with 2% spray (P=0.02). There were no significant differences between the 2 groups in esophageal dysplasia detection and color evaluation, and no additional adverse events were noted in either group.
COMMENT
Lugol’s iodine solution in the 1% concentration should be used in patients undergoing dye-spray chromoendoscopy for the detection or delineation of esophageal squamous cell lesions. Compared to the higher concentration, the 1% spray is associated with less chest discomfort.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Prateek Sharma, MD, FASGE
CITATION(S)
Gotoda T, Kanzaki H, Okamoto Y, et al. Tolerability and efficacy due to the concentration of iodine solution during esophageal chromoendoscopy: a double-blind randomized controlled trial. Gastrointest Endosc 2019 Oct 25. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.10.022)
