title: Cancer prevention in ulcerative colitis: long-term outcome following fluorescence-guided colonoscopy.
abstract: BACKGROUND
  Patients with long-standing ulcerative colitis require repeated endoscopies for early detection of neoplasias, which, however, are frequently missed by standard colonoscopy. Fluorescence-guided colonoscopy is known to improve the detection rate but the long-term effects of fluorescence-guided colonoscopy are unknown.
  
  
  METHODS
  Colitis patients with negative findings at index fluorescence-guided colonoscopy entered a prospective long-term study with conventional colonoscopies at 2-year intervals. Risk and time to progression were evaluated. The positive predictive value was assessed in patients with neoplasias at index fluorescence-guided colonoscopy who underwent immediate total colectomy.
  
  
  RESULTS
  Thirty-one patients with negative fluorescence-guided colonoscopy were surveyed for a mean of 7.8 ± 0.9 years. Neoplasia was observed in only two of them (6%) after 7 and 8 years of follow-up, respectively. Neoplasia at index fluorescence-guided colonoscopy was observed in 10 patients. In all of them, multiple flat low-grade intraepithelial neoplasia was diagnosed. At immediate colectomy performed in eight of them, the diagnosis of flat low-grade intraepithelial neoplasia was confirmed, corresponding to a positive predictive value of 100%. However, synchronous more advanced neoplasia was detected in three of the eight patients (38%). All patients, those with and those without neoplasia, were alive at the end of the study.
  
  
  CONCLUSIONS
  Fluorescence-guided colonoscopy misses, in contrast to standard colonoscopy, few, if any, patients with neoplasia. Most neoplasia-negative patients remain negative during prolonged follow-up. However, when low-grade dysplasia is diagnosed by fluorescence-guided colonoscopy, colectomy is recommended because more than a third of the patients harbor synchronous, more advanced neoplasia.
authors.affiliation: Mediankliniken Gruenheide, Germany.
authors.forename: Virginia
authors.initials: V
authors.lastname: Fusco
authors.forename: Bernd
authors.initials: B
authors.lastname: Ebert
authors.forename: Jutta
authors.initials: J
authors.lastname: Weber-Eibel
authors.forename: Christian
authors.initials: C
authors.lastname: Jost
authors.forename: Barbara
authors.initials: B
authors.lastname: Fleige
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.forename: Georg
authors.initials: G
authors.lastname: Oberhuber
authors.forename: Herbert
authors.initials: H
authors.lastname: Rinneberg
authors.forename: Herbert
authors.initials: H
authors.lastname: Lochs
authors.forename: Marianne
authors.initials: M
authors.lastname: Ortner
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000473:pathology*; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy; D005260:Female; D005453:Fluorescence; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011237:Predictive Value of Tests; D013997:Time Factors