Reply to Souza et al.

Reply to Souza et al.

The two cases described by Souza et al. are interesting because they draw attention to the possibility of colitis due to disinfecting electrolyzed solutions containing sodium chloride at low concentrations [1]. Both reported cases had endoscopic and histologic features resembling the so-called pseudolipomatosis. Other future observations will clarify whether the characteristic whitish plaques configuring the “snow white” sign are caused by the compounds of the electrolyzed acid water or whether they are due to technical failure in the rinsing of the endoscope channels. However, the low incidence of cases (two out of approximately 3000 exams per year) seems to indicate an accidental cause. We agree with the authors when they concluded that the pseudolipomatosis entity may have various causes that are not yet clearly understood. It seems certain, however, that the previously called pseudolipomatosis is caused by chemical agents, and therefore it seems correct to include it in the wider issue of “chemical colitis” [2]. Really, endoscopists should be aware of this possibility when observing the “snow white” sign during colonoscopy, which cannot be attributed to organic disease of the colon.

Competing interests: None

References

• 1 Nelson D. Newer technologies for endoscope disinfection: electrolyzed acid water and disposable-component endoscope systems.  Gastrointest Endosc Clin N Am. 2000;  10 319-328
• 2 Sheibani S, Gerson L B. Chemical colitis.  J Clin Gastroenterol. 2008;  42 115-121