Endoscopy 2010; 42(1): 28-33
DOI: 10.1055/s-0029-1243804
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Hexaminolevulinate-induced fluorescence colonoscopy versus white light endoscopy for diagnosis of neoplastic lesions in the colon

B.  Mayinger1 , F.  Neumann1 , C.  Kastner1 , T.  Haider2 , D.  Schwab3
  • 1Department of Medicine II, Hospital Munich-Pasing, Teaching Hospital of the University of Munich (LMU), Germany
  • 2LINK Medical Research, Oslo, Norway
  • 3Department of Medicine, Hospital Martha-Maria, Teaching Hospital of the University of Erlangen (FAU), Nürnberg, Germany
Weitere Informationen

Publikationsverlauf

submitted 15 June 2009

accepted after revision 20 August 2009

Publikationsdatum:
11. Januar 2010 (online)

Background and study aims: To compare the rate of detection of colorectal neoplastic lesions using the selective photosensitizer precursor hexaminolevulinate (HAL) combined with a new fluorescence video endoscope system against that of standard white light endoscopy, and secondarily, to evaluate the safety profile of HAL-induced fluorescence colonoscopy.

Patients and methods: This prospective phase II clinical pilot study from two hospital study centers included 25 patients with known or highly suspected colorectal neoplasia. They underwent sensitization with locally applied 500 ml HAL enemas at a concentration of 1.6 mmol/L. At 60 minutes after enteral HAL administration, fluorescence imaging was done using a special light source capable of delivering either white light or blue excitation light. Red fluorescence induced by illumination with blue light was detected via a prototype fluorescence video colonoscope. Biopsies were taken from suspicious areas found with white or blue light.

Results: Using histology as the gold standard, 55 / 93 of neoplastic lesions were detected with white light endoscopy, 53 / 93 with both white and blue light, 38 / 93 with blue light and second-pass white light, and 27/93 with blue light only. Of all neoplastic lesions, 91 / 93 revealed red fluorescence under fluorescence imaging (P < 0.0001). Fluorescence mode showed 38.7 % (36 / 93) more neoplasms than did white light endoscopy. An isolated slight elevation of bilirubin, by a factor of 1.5, was noted after the administration of HAL.

Conclusions: Administration of HAL as enema induces selective lesion fluorescence and increases lesion detection rate in patients with colorectal neoplasia, especially of flat, nonvisible adenomas.

References

  • 1 Hixson L J, Fennerty M B, Sampliner R E. et al . Prospective study of the frequency and size distribution of polyps missed by colonoscopy.  J Natl Cancer Inst. 1990;  82 1769-1772
  • 2 Rex D K, Cutler C S, Lemmel G T. et al . Colonoscopic missing rates of adenomas determined by back-to-back colonoscopies.  Gastroenterology. 1997;  112 24-28
  • 3 Benson S, Mott L A, Dain B. et al . For the Polyp Prevention Study Group. The colonoscopic miss rate and true one-year recurrence of colorectal neoplastic polyps.  Am J Gastroenterol. 1999;  94 194-199
  • 4 Pickhardt P J, Nugent P A, Mysliwiec P A. et al . Location of adenomas missed by optical colonoscopy.  Ann Intern Med. 2004;  141 352-359
  • 5 Kasugal K, Miyata M, Hashimoto T. et al . Assessment of miss and incidence rates of neoplastic polyps at colonoscopy.  Dig Endosc. 2005;  17 44-49
  • 6 Heresbach D, Barrioz T, Lapalus M G. et al . Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to back video colonoscopy.  Endoscopy. 2008;  40 284-290
  • 7 Kiesslich R, Moenk S, Reinhardt K. et al . Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis.  Gastroenterology. 2003;  124 880-888
  • 8 Messmann H, Endlicher E, Freunek G. et al . Fluorescence endoscopy for the detection of low and high grade dysplasia in ulcerative colitis using systemic or local 5-aminolaevulinic acid sensitisation.  Gut. 2003;  52 1003-1007
  • 9 Mayinger B, Guenther K, Horner P. et al . Diagnosis of rectal cancer and adenoma with light-induced autofluorescence spectroscopy.  J Photochem Photobiol B. 2003;  70 13-20
  • 10 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
  • 11 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;  48 314-319
  • 12 Messmann H, Endlicher E, Freunek G. et al . Fluorescence endoscopy for the detection of low and high grade dysplasia in ulcerative colitis using systemic or local 5-aminolaevulinic acid sensitisation.  Gut. 2003;  52 1003-1007
  • 13 Ochsenkuhn T, Tillack C, Stepp H. et al . Low frequency of colorectal dysplasia in patients with long-standing inflammatory bowel disease colitis; detection by fluorescence endoscopy.  Endoscopy. 2006;  38 477-482
  • 14 Endlicher E, Rümmele P, Hausmann F. et al . Detection of dysplastic lesions by fluorescence in a model of chronic colitis in rats after local application of 5-aminolevulinic acid and its esterified derivatives.  Photochem Photobiol. 2004;  79 189-192
  • 15 Endlicher E, Gelbmann C M, Knüchel R. et al . Hexaminolevulinate-induced fluorescence endoscopy in patients with rectal adenoma and cancer: a pilot study.  Gastrointest Endosc. 2004;  60 449-454
  • 16 Klem B, Lappin G, Nicholson S. et al . Determination of the bioavailability of [14C]-hexaminolevulinate using accelerator mass spectrometry after intravesical administration in human volunteers.  J Clin Pharmacol. 2006;  46 456-460
  • 17 Mayinger B, Neumann F, Kastner C. et al . Early detection of premalignant conditions in the colon by fluorescence endoscopy using local sensitization with hexaminolevulinate.  Endoscopy. 2008;  40 106-109
  • 18 Jocham D, Witjes F, Wagner S. et al . Improved detection and treatment of bladder cancer using hexaminolevulinate imaging: a prospective, phase III multicenter study.  J Urol. 2005;  174 862-866
  • 19 Grossman H B, Gomella L, Fradet Y. et al . A phase III, multicenter comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of superficial papillary lesions in patients with bladder cancer.  J Urol. 2007;  178 62-67
  • 20 Fradet Y, Grossman H B, Gomella L. et al . A comparison of hexaminolevulinate fluorescence cystoscopy and white light cystoscopy for the detection of carcinoma in situ in patients with bladder cancer: a phase III, multicenter study.  J Urol. 2007;  178 68-73

B. MayingerMD, PhD 

Department of Medicine II
Hospital Munich-Pasing

Steinerweg 5
D-81241 Munich
Germany

Fax: +49-89-88922411

eMail: brigitte.mayinger@krankenhaus-pasing.de