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Background and Study Aim: Patients with long-standing in-flammatory bowel disease (IBD) have an increased risk of developing colonic dysplasias. Dysplastic changes in flat mucosa are likely to be missed by conventional colonoscopy. Endoscopic fluorescence imaging, using 5-aminolevulinic acid (5-ALA) as photosensitizer, has evolved as a new technique to differentiate between normal colonic mucosa and dysplasia. We combined this technique with random biopsies to prospectively evaluate the occurrence of dysplasias in patients with long-standing IBD. Patients and Methods: 52 colonoscopies were performed in 42 consecutive patients (n = 28 with ulcerative colitis, n = 11 with Crohn’s colitis, n = 3 with indeterminate colitis; mean age 43 years, range 21-78) with long-standing IBD colitis (median disease duration 14 years, range 3-40). All patients were in clinical remission. Patients were examined using both conventional white light and by fluorescence colonoscopy using oral 5-ALA. Four biopsies were taken every 10cm frommucosa of normal appearance. In addition, macroscopically suspicious and fluorescence-positive areas were biopsied. Results: A total of 688 biopsies of red-fluorescent (n = 20) and nonfluorescent (n = 662) areas of mucosa were taken. Dysplasia was detected histopathologically in only two of the biopsies. These biopsies were taken from two polypoid lesions which were fluorescence-negative. Conclusions: The rate of colonic dysplasia in patients with long-standing IBD colitis may be lower than previously reported.
Background and Study Aim: Patients with long-standing in-flammatory bowel disease (IBD) have an increased risk of developing colonic dysplasias. Dysplastic changes in flat mucosa are likely to be missed by conventional colonoscopy. Endoscopic fluorescence imaging, using 5-aminolevulinic acid (5-ALA) as photosensitizer, has evolved as a new technique to differentiate between normal colonic mucosa and dysplasia. We combined this technique with random biopsies to prospectively evaluate the occurrence of dysplasias in patients with long-standing IBD. Patients and Methods: 52 colonoscopies were performed in 42 consecutive patients (n = 28 with ulcerative colitis, n = 11 with Crohn’s colitis, n = 3 with indeterminate colitis; mean age 43 years, range 21-78) with long-standing IBD colitis years, range 3-40). All patients were in clinical remission. Patients were examined using both conventional white light and by fluorescence colonoscopy using oral 5-ALA. Four biop Results: A total of 688 biopsies of red-fluorescent (n = 20) and nonfluorescent (n = 662) areas of mucosa were These biopsies were taken from two polypoid lesions which were fluorescence-negative. Conclusions: The rate of colonic dysplasia in patients with long-standing IBD colitis may be lower than previously reported.