3449 Detection of colonic dysplasia by laser-induced fluorescence endoscopy with and without 5- aminolevulinic acid

• Published in: Gastrointestinal endoscopy 2000-04, Vol.51 (4), p.AB95-AB95
• Main Authors: Ott, Stephan J., Ochsenkuehn, Thomas, Stepp, Herbert, Holl, Joseph, Brand, Stephan, Pauletzki, Juergen, Baumgartner, Reinhold, Sackmann, Michael
• Format: Article
• Language: English
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(00)14149-5

Patients with long-standing inflammatory bowel disease (IBD) are at increased risk of developing colonic dysplasias. By conventional colonoscopy dysplasias may be difficult to detect. Laser induced flourescence endoscopy (LIFE) helps to differentiate between normal colonic mucosa and dysplasia. We present results of a pilot study using LIFE with and without 5-Aminolevulinic acid in patients with IBD. Methods: 15 patients with IBD were screened for colonic dysplasias with LIFE using autofluorescence (group A, 5 patients) or 5-ALA induced fluorescence (group B, 10 patients) combined with white light colonoscopy during a routine endoscopic examination. 5-ALA was given orally at a dose of 20mg/kg 3 hours before examination. All patients were examined by conventional white light colonoscopy and by LIFE using a blue light source (400-410 nm) and a sensitive camera to detect the laser induced fluorescence (D-Light/Tricam SL, Storz, Germany). All procedures were documentated with video. All lesions were judged to be suspicious or non-suspicious (regarding dysplasia) by both conventional colonoscopy and LIFE. The LIFE images were classified as positive for dysplasia (“red” flourescence) or negative (“green” or “blue” fluorescence like normal mucosa). Biopsies were taken, from all suspicious areas for histological assessment. Results: In both group A and group B no dysplasias or carcinomas were detectet histopathologically. In 4 patients of group B white light colonoscopy showed suspicious areas (4 false positive results), one of these suspicious lesions was also positive in the 5-ALA fluorescence (1 false positive). No suspicious lesions or dysplasias were detected in the autofluorescence group. Conclusions: In this small series of patients LIFE from colonic mucosa with or without 5-ALA combined with routine white light colonoscopy shows a good correlation with the histopathological findings and a high sensitivity. Due to the absence of dysplasias or carcinomas in this population the specifity cannot be determined. If the high sensitivity of LIFE compared to conventional colonoscopy will be confirmed in further studies, routine random biopsies in the surveillance of IBD patients may be avoided by Life.