# Iodine Staining With Distance Countdown Improving the Safety for Reduction of Adverse Events: A Randomized Controlled Trial

## TL;DR

A new technique called distance countdown reduces iodine reflux and other adverse events during esophageal cancer screening with iodine staining.

## Contribution

The distance countdown model significantly reduces iodine solution reflux and related adverse events during Lugol chromoendoscopy.

## Key findings

- The DC group had a 1.0% iodine reflux rate compared to 26.5% in the No-DC group.
- Bucking incidence was 1.0% in the DC group versus 9.8% in the No-DC group.
- Symptoms like sore throat and heartburn were reduced in the DC group.

## Abstract

Lugol chromoendoscopy (LCE) is valuable, cost-effective, and widely used in early esophageal cancer screening, yet it suffers from low compliance because of adverse events after LCE. In addition, the reflux of iodine during iodine staining in the upper esophagus brings the risk of bucking and aspiration. We introduced a new model called distance countdown (DC) aimed to reduce reflux during iodine staining in upper esophageal LCE.

In this randomized controlled trial, 204 patients were randomized into the DC and No-DC groups. The primary end point was the difference in the incidence of positive starch reagent reaction (iodine solution reflux) between the 2 groups. The secondary end points were the comparisons of the incidence of other adverse events after LCE between the 2 groups.

The rate of iodine solution reflux was 1.0% in the DC group and 26.5% in the No-DC group (P < 0.001). Furthermore, the incidences of bucking between the 2 groups were 1.0% and 9.8% (P = 0.005). LCE satisfaction rates were 78.4% and 76.5% in the DC and No-DC groups (P = 0.363), respectively. Concerning symptoms after LCE, incidences of sore throat, pharyngeal discomfort or odor, bitter taste, and heartburn were also reduced in the DC group (all P < 0.05).

Adding DC as an auxiliary effect during LCE would reduce the risk of iodine solution reflux, as well as other adverse events after LCE. Implementing this measure could be beneficial in improving the safety of LCE in early esophageal cancer screening.