Research Progress and Evidence-Based Evaluation of Chromoendoscopy in Colonoscopy

Abstract

Colorectal cancer is a high-incidence malignant tumor of the digestive tract worldwide. Colonoscopic screening and complete resection of early lesions serve as the core strategies to reduce its morbidity and mortality. Conventional white-light endoscopy (WLE) exhibits a high missed diagnosis rate for minute adenomas, flat lesions, laterally spreading tumors (LSTs), and inflammatory bowel disease (IBD)-associated dysplasia, which fails to meet the demands of precise early diagnosis. Chromoendoscopy (CE) enhances the fine mucosal microstructure, crypt morphology, and lesion boundaries via topical mucosal spraying of staining agents, thereby significantly improving lesion detection efficacy. Based on evidence-based medical data, this study systematically summarizes the mechanism of action, characteristics of commonly used staining agents, standardized operating procedures, and quality control key points of CE. By integrating randomized controlled trials (RCTs), meta-analyses, and domestic and international authoritative guidelines, this paper hierarchically evaluates its clinical value in adenoma detection, early colorectal cancer diagnosis, LST assessment, IBD-related dysplasia screening, and postoperative follow-up. It further conducts an evidence-based comparison of the diagnostic efficacy among CE, WLE, virtual chromoendoscopy, magnifying endoscopy, and artificial intelligence (AI)-assisted endoscopy. Additionally, the current limitations of existing studies are objectively summarized, and future research directions of this technology are prospected, aiming to provide evidence-based references for the standardized implementation of enhanced colonoscopy and the construction of a stratified early screening strategy for colorectal cancer.