• Ammar O. Kheir
  • Roy Soetikno
  • Tonya KaltenbachEmail author


Gastrointestinal cancers represent the leading cause of cancer-related death worldwide. The detection, diagnosis, and treatment of precursor and early gastrointestinal cancers are critical for improvements in morbidity and mortality. Often subtle in appearance, these pre- and early cancers can pose a challenge to endoscopic visualization with white light. Image enhancement using chromoendoscopy, through the application of dye solutions, has been shown to facilitate visualization to improve endoscopic localization, characterization, and therapy. In this review, we will focus on the techniques and tools of chromoendoscopy available in the United States including Lugol’s solution for squamous cell carcinoma of the esophagus, and indigo carmine and methylene blue for high-risk surveillance populations such as Barrett’s esophagus, inflammatory bowel disease, and hereditary nonpolyposis colorectal cancer syndrome.


Endoscopy Colonoscopy Surveillance Image-enhanced endoscopy Lugol’s solution Indigo carmine Methylene blue Gastrointestinal cancer Dysplasia Inflammatory bowel disease Barrett’s esophagus 

Supplementary material

Video 3.1

Lugol’s esophageal squamous cell high grade dysplasia (MP4 11,489 kb)

Video 3.2

Indigo carmine preparation (MP4 28,426 kb)

Video 3.3

Chromoendoscopy technique (MP4 59,081 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Ammar O. Kheir
    • 1
    • 2
  • Roy Soetikno
    • 3
    • 4
    • 5
  • Tonya Kaltenbach
    • 6
    Email author
  1. 1.Department of GastroenterologyQueen Elizabeth II Jubilee HospitalBrisbaneAustralia
  2. 2.School of Medicine and Public HealthUniversity of NewcastleNewcastleAustralia
  3. 3.Department of Gastroenterology and HepatologySingapore General HospitalSingaporeSingapore
  4. 4.National Cancer Center SingaporeSingaporeSingapore
  5. 5.Duke–National University Singapore Graduate Medical SchoolSingaporeSingapore
  6. 6.Veteran Affairs Palo Alto Health Care System and Stanford University School of MedicinePalo AltoUSA

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