Indigo carmine chromoendoscopic appearances of enteropathy-associated T-cell lymphoma during double-balloon endoscopy in a patient with celiac disease.

fold increased risk of developing enterop− athy−associated T−cell lymphoma com− pared with the general population [1]. Early diagnosis is therefore required to improve their prospects. Indigo carmine chromoendoscopy highlights mucosal ir− regularities and improves the detection of malignant lesions [2]. Furthermore, it can delineate villous atrophy in celiac dis− ease [3]. This method is commonly used in upper and lower gastrointestinal en− doscopy but this is not yet the case in small−intestinal endoscopy. In this report we describe the chromoendoscopic ap− pearances of jejunal enteropathy−asso− ciated T−cell lymphoma, before and after indigo carmine spraying, in a patient who was undergoing a double−balloon endoscopy procedure. A 68−year−old Caucasian woman with ce− liac disease who had been on a gluten− free diet for 3 years was referred for dou− ble−balloon endoscopy because an ab− dominal computed tomography scan had shown thickened small−intestinal wall. Endoscopy was performed with a dou− ble−balloon endoscopy system (FMH Medical Inc., Veenendaal, The Nether− lands). Using a catheter, 10 mL of a 0.1% solution of indigo carmine was sprayed onto the jejunal mucosa on withdrawal of the endoscope. Scalloping or loss of folds, a mosaic ap− pearance of the jejunal mucosa, and round or circumferential ulcers (10± 90 mm along their longitudinal axis) were detected with standard video en− doscopy, but the villi were easier to re− cognize after indigo carmine staining of scalloped jejunal folds (l" Figure 1) and ulcers were also highlighted (l" Figure 2, l" 3). Histological examination revealed the presence of enteropathy−associated T−cell lymphoma in biopsies taken from the ulcers and partial to subtotal villous atrophy in the nonulcerated mucosa. In comparison with standard endoscopy, indigo carmine chromoendoscopy high− lighted areas of villous atrophy [4] and ul− Indigo carmine chromoendoscopic appearances of enteropathy−associated T−cell lymphoma during double−balloon endoscopy in a patient with celiac disease