Cancer prevention in ulcerative colitis: Long‐term outcome following fluorescence‐guided colonoscopy

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. (Inflamm Bowel Dis 2012;)