Endoscopic visualization of cancer and dysplasia in patients with ulcerative colitis following sensitization with oral 5-aminolevulinic acid.

AIM Early diagnosis of colitis-associated cancer and dysplasia through surveillance endoscopy is vital in patients with ulcerative colitis. This study aimed to evaluate the efficacy of autofluorescence endoscopy using 5-aminolevulinic acid and investigate the fluorescence signal localization pattern following 5-aminolevulinic acid administration in tumorous lesions diagnosed as colitis-associated cancer and dysplasia. The sensitivity and specificity of tumorous lesions detected by white light endoscopy with and without autofluorescence endoscopy were evaluated. METHODS Thirteen endoscopic procedures were performed in 11 patients with ulcerative colitis using white-light endoscopy and autofluorescence endoscopy following the oral administration of 5-aminolevulinic acid. The biopsied lesions detected via endoscopy and resected specimens from colectomy cases were assessed histopathologically. The sensitivity and specificity of the detected tumorous lesions by white-light endoscopy with and without autofluorescence endoscopy were evaluated. RESULTS Of the 68 lesions detected and biopsied, 63 were detected via white-light endoscopy, and 5 were detected via autofluorescence endoscopy alone. The sensitivity of colitis-associated cancer and dysplasia detected via autofluorescence endoscopy combined with white-light endoscopy was 36%, and the specificity, positive predictive value, and negative predictive value were 94%, 57%, and 87%, respectively. Tumorous lesions demonstrated three types of fluorescence patterns on autofluorescence endoscopy. CONCLUSIONS Autofluorescence endoscopy using 5-aminolevulinic acid can detect colitis-associated cancer and dysplasia lesions in patients with long-standing ulcerative colitis and lesions that could not be detected via white-light endoscopy. Distinctive fluorescence patterns in lesions could allow for the qualitative diagnoses of colitis-associated cancer and dysplasia lesions.