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Fluorescence endoscopy for the detection of low and high grade dysplasia in ulcerative colitis using systemic or local 5-aminolaevulinic acid sensitization. Messmann H, Endlicher E, Freunek G, Rummele P, Scholmerich J, Knuchel R. (Departments of Internal Medicine and Pathology, University of Regensberg, Germany). Gut 2003;52:1003–1007.

Four quadrant biopsies at every 10 cm in patients with inflammatory bowel disease undergoing surveillance colonoscopy remains the gold standard, but it is neither ideal nor economically justified. The ability to detect dysplasia or cancer in flat mucosa that is not visible to the naked eye is the goal of a number of optical techniques currently under development. Messmann et al have provided an early but encouraging report on fluorescence endoscopy following the administration of 5-aminolevulinic acid (5-ALA).

The study was carried out in 37 patients (22 female and 15 male) with ulcerative colitis of longer than 5 years' duration. All patients were in remission with pancolitis or left sided colitis; those with acute inflammation were excluded. 5-ALA was administered either orally (dissolved in orange juice), as a retention enema, or by spraying a solution directly on to the colonic mucosa. Fluorescence endoscopy was performed 4–6 hours after oral administration and 1−2 hours after enema or spray. The colonoscope was connected to a light source that alternately delivered white or blue (390–405 nm) light. Endoscopic biopsies were obtained from areas of red fluorescence under blue light illumination (n = 218) and then randomly under white light from non-fluorescent areas (n = 263).

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