Download PDF
Endoscopy 2003; 35(8): 663-668
DOI: 10.1055/s-2003-41514
Original Article

© Georg Thieme Verlag Stuttgart · New York

Endoscopic Fluorescence Detection of Intraepithelial Neoplasia in Barrett's Esophagus after Oral Administration of Aminolevulinic Acid

T.  Stepinac 1 , C.  Felley 2 , P. Jornod 2 , N.  Lange 1 , T.  Gabrecht 1 , C.  Fontolliet 3 , P.  Grosjean 4 , G.  van Melle 5 , H.  van den Bergh 1 , P.  Monnier 4 , G.  Wagnières 1 , G.  Dorta 2
  • 1 Institute of Environmental Engineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
  • 2 Division of Gastroenterology, Centre Hospitalier Universitaire Vaudois Hospital, Lausanne, Switzerland
  • 3 Institute of Pathology, Centre Hospitalier Universitaire Vaudois Hospital, Lausanne, Switzerland
  • 4 Department of ENT, Centre Hospitalier Universitaire Vaudois Hospital, Lausanne, Switzerland
  • 5 Division of Statistics, Lausanne University, Lausanne, Switzerland
Further Information

Publication History

Submitted 11 July 2002

Accepted after Revision after revision: 16 March 2003

Publication Date:
20 August 2003 (online)

Also available at
    Permissions and Reprints

Background and Study Aims: Barrett's esophagus is strongly associated with adenocarcinoma. Early malignant transformation of the Barrett's mucosa is often not visible endoscopically and may remain undetected until the invasive adenocarcinoma stage. Endoscopic surveillance is currently carried out on random four-quadrant biopsies at 1-2 cm intervals. Endoscopic fluorescence detection of protoporphyrin IX induced by 5-aminolevulinic acid can identify premalignant lesions. This study evaluates endoscopic fluorescence detection in patients having Barrett's esophagus and compares the results to those of standard endoscopy with random four-quadrant biopsies.Patients and Methods: The study included 30 examinations in 28 patients (22 men, 6 women; age range 37-78 years, mean age 60 years,), with five patients having known intraepithelial neoplasia. A dose of 20 mg/kg of 5-aminolevulinic acid was given orally 5 hours before examination. Random four-quadrant biopsies were performed 4-6 weeks before endoscopic fluorescence detection.Results: Of the biopsies taken during the endoscopic fluorescence detection procedure, 28 % (23/81) were true positives. More than one-third of the false-positive results were due to inflammation. None of the 97 control biopsies taken on nonfluorescing areas during endoscopic fluorescence detection were dysplastic. Endoscopic fluorescence detection showed low-grade intraepithelial neoplasia in five patients which was not diagnosed with random four-quadrant biopsies, while random four-quadrant biopsies alone showed three low-grade intraepithelial neoplasias that were invisible during endoscopic fluorescence detection. All high-grade intraepithelial neoplasias or adenocarcinomas (2/2) were detected with both methods.Conclusions: Fluorescence detection achieved a similar performance when compared with four-quadrant random biopsy, but resulted in fewer biopsies (81 for endoscopic fluorescence detection vs 531 for random four-quadrant biopsies).

References

  • 1 Spechler S J. Barrett's esophagus.  N Engl J Med. 2002;  346 836-842
    CrossrefPubMedSearch in Google Scholar
  • 2 Spechler S J. Epidemiology and natural history of gastroesophageal reflux disease.  Digestion. 1992;  51 24-29
    CrossrefPubMedSearch in Google Scholar
  • 3 Winters C, Spurling T, Chobanian S. et al . Barrett's esophagus. A prevalent, occult complication of gastroesophageal reflux disease.  Gastroenterology. 1987;  92 118-124
    CrossrefPubMedSearch in Google Scholar
  • 4 Drewitz D, Sampliner R, Garewal H. The incidence of adenocarcinoma in Barrett's esophagus: a prospective study of 170 patients followed 4.8 years.  Am J Gastroenterol. 1997;  92 212-215
    PubMedSearch in Google Scholar
  • 5 O'Connor J, Falk G, Richter J. The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: report on the Cleveland Clinic Barrett's Esophagus Registry.  Am J Gastroenterol. 1999;  94 2037-2042
    PubMedSearch in Google Scholar
  • 6 Overholt B. Results of photodynamic therapy in Barrett's esophagus: a review.  Can J Gastroenterol. 1999;  13 393-396
    PubMedSearch in Google Scholar
  • 7 Levine D S. Management of dysplasia in the columnar-lined esophagus.  Gastroenterol Clin N Am. 1997;  26 613-634
    PubMedSearch in Google Scholar
  • 8 Falk G W. Barrett's esophagus.  Gastroenterology. 2002;  122 1569-1591
    PubMedSearch in Google Scholar
  • 9 Heitmiller R F, Redmond M, Hamilton S R. Barrett's esophagus with high-grade dysplasia - an indication for prophylactic esophagectomy.  Ann Surg. 1996;  224 66-71
    CrossrefPubMedSearch in Google Scholar
  • 10 Sampliner R E. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett's esophagus.  Am J Gastroenterol. 1998;  93 1028-1032
    CrossrefPubMedSearch in Google Scholar
  • 11 Tytgat G NJ. Does endoscopic surveillance in esophageal columnar metaplasia (Barrett's esophagus) have any real value?.  Endoscopy. 1995;  27 19-26
    PubMedSearch in Google Scholar
  • 12 Falk G W, Chittajallu R, Goldblum J R. et al . Surveillance of patients with Barrett's esophagus for dysplasia and cancer with balloon cytology.  Gastroenterology. 1997;  112 1787-1797
    CrossrefPubMedSearch in Google Scholar
  • 13 Waxman I. Endosonography in columnar-lined esophagus.  Gastroenterol Clin N Am. 1997;  26 607-612
    PubMedSearch in Google Scholar
  • 14 Levine M S, Herman J B, Furth E E. Barrett's esophagus and esophageal adenocarcinoma - the scope of the problem.  Abdom Imaging. 1995;  20 291-298
    CrossrefPubMedSearch in Google Scholar
  • 15 Canto M IF, Setrakian S, Willis J E. et al . Methylene blue staining of dysplastic and nondysplastic Barrett's esophagus: An in vivo and ex vivo study.  Endoscopy. 2001;  33 391-400
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Peng Q, Berg K, Moan J. et al . 5-aminolevulinic acid-based photodynamic therapy: principles and experimental research.  Photochem Photobiol. 1997;  65 235-251
    CrossrefPubMedSearch in Google Scholar
  • 17 Stepp H, Sroka R, Baumgartner R. Fluorescence endoscopy of gastrointestinal diseases: basic principles, techniques, and clinical experience.  Endoscopy. 1998;  30 379-386
    PubMedSearch in Google Scholar
  • 18 Gossner L, Stolte M, Sroka R. et al . Photodynamic ablation of high-grade dysplasia and early cancer in Barrett's esophagus by means of 5-aminolevulinic acid.  Gastroenterology. 1998;  114 448-455
    PubMedSearch in Google Scholar
  • 19 Webber J, Kessel D, Fromm D. Side effects and photosensitization of human tissues after aminolevulinic acid.  J Surg Res. 1997;  68 31-37
    CrossrefPubMedSearch in Google Scholar
  • 20 Pech O, Gossner L, May A. et al . Management of Barrett's oesophagus, dysplasia and early adenocarcinoma.  Best Pract Res Clin Gastroenterol. 2001;  15 267-84
    PubMedSearch in Google Scholar
  • 21 Endlicher E, Knuechel R, Hauser T. et al . Endoscopic fluorescence detection of low and high grade dysplasia in Barrett's oesophagus using systemic or local 5-aminolaevulinic acid sensitisation.  Gut. 2001;  48 314-349
    CrossrefPubMedSearch in Google Scholar
  • 22 Brand S, Wang T D, Schomacker K T. et al . Detection of high-grade dysplasia in Barrett's esophagus by spectroscopy measurement of 5-aminolevulinic acid-induced protoporphyrin IX fluorescence.  Gastrointest Endosc. 2002;  56 479-487
    CrossrefPubMedSearch in Google Scholar
  • 23 Messmann H, Endlicher E, Gelbmann C M. et al . Fluorescence endoscopy and photodynamic therapy.  Dig Liver Dis. 2002;  34 754-761
    CrossrefPubMedSearch in Google Scholar
  • 24 Mayinger B, Neidhardt S, Reh H. et al . Fluorescence induced with 5-aminolevulinic acid for the endoscopic detection and follow-up of esophageal lesions.  Gastrointest Endosc. 2001;  54 572-578
    CrossrefPubMedSearch in Google Scholar
  • 25 Kelty C J, Brown N J, Reed M WR. et al . The use of 5-aminolaevulinic acid as a photosensitiser in photodynamic therapy and photodiagnosis.  Photochem Photobiol Sci. 2002;  1 158-168
    CrossrefPubMedSearch in Google Scholar
  • 26 Sackmann M. Fluorescence diagnosis in gastrointestinal endoscopy.  Endoscopy. 2000;  32 977-985
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Uehlinger P, Zellweger M, Wagnieres G. et al . 5-Aminolevulinic acid and its derivatives: physical chemical properties and protoporphyrin IX formation in cultured cells.  J Photochem Photobiol B. 2000;  54 72-80
    CrossrefPubMedSearch in Google Scholar
  • 28 Lange N, Jichlinski P, Zellweger M. et al . Photodetection of early human bladder cancer based on the fluorescence of 5-aminolaevulinic acid hexylester-induced protoporphyrin IX: a pilot study.  Br J Cancer. 1999;  80 185-193
    CrossrefPubMedSearch in Google Scholar
  • 29 Kiesslich R, Jung M. Magnification endoscopy: does it improve mucosal surface analysis for the diagnosis of gastrointestinal neoplasias?.  Endoscopy. 2002;  34 819-822
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Lambert R, Rey J F. Endoscopy and early neoplasia: better but not the best.  Endoscopy. 2001;  33 348-352
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Koop H. State-of-the-art review. Gastroesophageal reflux disease and Barrett's esophagus.  Endoscopy. 2002;  34 97-103
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Rösch T. DDW Report. Reflux disease and Barrett's esophagus.  Endoscopy. 2002;  34 851-859
    Thieme ConnectPubMedSearch in Google Scholar
  • 33 Ito S, Muguruma N, KusakaY . et al . Detection of human gastric cancer in resected specimens using a novel infrared fluorescent anti-human carcinoembryonic antigen antibody with an infrared fluorescence endoscope in vitro.  Endoscopy. 2001;  33 849-853
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 DaCosta R S, Wilson B C, Marcon N E. New optical technologies for earlier endoscopic diagnosis of premalignant gastrointestinal lesions.  J Gastroenterol Hepatol. 2002;  17 S85-S104
    CrossrefPubMedSearch in Google Scholar
  • 35 Panjehpour M, Overholt B F, VoDinh T. et al . Endoscopic fluorescence detection of high-grade dysplasia in Barrett's esophagus.  Gastroenterology. 1996;  111 93-101
    CrossrefPubMedSearch in Google Scholar
  • 36 Haringsma J, Tytgat G NJ, Yano H. et al . Autofluorescence endoscopy: feasibility of detection of GI neoplasms unapparent to white light endoscopy with an evolving technology.  Gastrointest Endosc. 2001;  53 642-650
    CrossrefPubMedSearch in Google Scholar
  • 37 Haringsma J, Prawirodirdjo W, Tytgat G NJ. Accuracy of fluorescence imaging of dysplasia in Barrett's esophagus.  Gastroenterology. 1999;  116 G1832
    PubMedSearch in Google Scholar

C. Felley, M. D.

Centre Hospitalier Universitaire Vaudois (CHUV) · Division of Gastroenterology

1011 Lausanne · Switzerland

Fax: +41-21-3140707

Email: christian.felley@chuv.hospvd.ch