- 作者：Maria-Anna Ortner ; Virginia Fusco ; Bernd Ebert ; Uwe Sukowski ; Jutta Weber-Eibel ; Barbara Fleige ; Manfred Stolte ; Georg Oberhuber ; Herbert Rinneberg ; Herbert Lochs
- 刊名：Gastrointestinal Endoscopy
- 出版年：2010
- 出版时间：February 2010
- 年：2010
- 卷：71
- 期：2
- 页码：312-318
- 全文大小：431 K
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.