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Endoscopy 2006; 38(5): 477-482
DOI: 10.1055/s-2006-925165
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Low Frequency of Colorectal Dysplasia in Patients with Long-Standing Inflammatory Bowel Disease Colitis: Detection by Fluorescence Endoscopy

T.  Ochsenkühn1 , C.  Tillack1 , H.  Stepp2 , J.  Diebold3 , S.  J.  Ott1 , R.  Baumgartner2 , S.  Brand1 , B.  Göke1 , M.  Sackmann1
  • 1Department of Medicine II, Klinikum Grosshadern, University of Munich, Germany
  • 2Laser Research Institute, Klinikum Grosshadern, University of Munich, Germany
  • 3Institute of Pathology Munich, Klinikum Grosshadern, University of Munich, Germany
Further Information

Publication History

Submitted 2 September 2004

Accepted after revision 5 September 2005

Publication Date:
09 May 2006 (online)

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Background and Study Aim: Patients with long-standing inflammatory 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 10 cm from mucosa 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.

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Thomas Ochsenkühn, M. D.

Department of Medicine II

University of Munich-Grosshadern · Marchioninistrasse 15 · 81 366 Munich · Germany

Fax: +49-89 70955291·

Email: thomas.ochsenkuehn@med.uni-muenchen.de