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Gastrointestinal Endoscopy

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Time-gated fluorescence spectroscopy improves endoscopic detection of low-grade dysplasia in ulcerative colitis - 22/08/11

Doi : 10.1016/j.gie.2009.09.029 
Maria-Anna Ortner, MD ⁎, Virginia Fusco, MD, Bernd Ebert, PhD, Uwe Sukowski, PhD, Jutta Weber-Eibel, MD, Barbara Fleige, MD, Manfred Stolte, MD, Georg Oberhuber, MD, Herbert Rinneberg, PhD, Herbert Lochs, MD
Current affiliations: Department of Gastroenterology (M.O.), University Hospital for Visceral Surgery and Medicine, University Hospital “Inselspital,” Bern, Switzerland, Department of Gastroenterology, Hepatology, and Endocrinology (V.F., J.W.-E., H.L.), Institute of Pathology (B.F.), Humboldt University, Charité, Berlin, Germany, Department of Medical Physics and Metrological Information Technology (B.E., U.S., H.R..), Department of Medical Physics and Metrological Information Technology, Berlin, Germany, Institute of Pathology (M.S.), Clinical Centre Kulmbach, Kulmbach, Germany, Institute of Pathology (G.O.), Clinical Centre Ueberlingen, Ueberlingen, Germany 

Reprint requests: Maria-Anna Ortner, MD, Department of Gastroenterology/UVCM, University Hospital “Inselspital,” Freiburgerstrasse, CH-3010 Bern, Switzerland.

Bern, Switzerland, Berlin, Kulmbach, Ueberlingen, Germany

Abstract

Background

Dysplasia in ulcerative colitis is frequently missed with 4-quadrant biopsies. An experimental setup recording delayed fluorescence spectra simultaneously with white light endoscopy was recently developed.

Objective

We compared detection of invisible flat intraepithelial neoplasia with protoporphyrin IX fluorescence and standard 4-quadrant biopsies.

Design

Prospective, crossover design without randomization of the order of procedures.

Setting

Gastroenterology Department, Humboldt University, Charité, Berlin, Germany.

Patients

Forty-two patients with extensive ulcerative colitis of more than 10 years’ duration were included.

Interventions

Colonoscopy with 4-quadrant biopsies and targeted biopsies of macroscopic lesions and time-gated fluorescence–guided colonoscopy were performed 2 weeks apart by 2 blinded endoscopists. Three independent pathologists examined the biopsy specimens.

Main Outcome Measurements

The primary outcome criterion was detection rate of invisible flat intraepithelial neoplasia.

Results

Invisible flat intraepithelial neoplasia was detected in 3 (7%) patients by white light 4-quadrant biopsies and in 10 (24%) patients by fluorescence-guided endoscopy (P = .02). The sensitivity and specificity for differentiating patients with and without dysplasia were 100% and 81%, respectively. Dysplastic and nondysplastic mucosa could be discriminated with a sensitivity and specificity of 73% and 81%, respectively.

Limitations

The trial was not randomized.

Conclusion

The detection rate of intraepithelial neoplasia in patients with ulcerative colitis can be improved by fluorescence-guided colonoscopy.

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Abbreviations : HGIN, IN, LGIN, 4-QB, PpIX


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 DISCLOSURE: The following author disclosed financial relationships relevant to this publication: M.-A. Ortner received support from the Ludwig Demling Stipendium, the Charité Foundation, and the Swiss National Foundation for Scientific Research 3200BO-112603. All other authors disclosed no financial relationships relevant to this publication.
 If you would like to chat with an author of this article, you may contact Dr. Ortner at ma.ortner@bluewin.ch.


© 2010  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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P. 312-318 - febbraio 2010 Ritorno al numero
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