Abstract
Background: The aim of this study was to investigate the use of orally administered 5-aminolevulinic
acid (ALA) for in vivo photodynamic diagnosis and follow-up of premalignant and malignant
esophageal lesions. Methods: Twenty-two patients with known or treated malignant and precancerous esophageal lesions
were sensitized with orally administered ALA (15 mg/kg). Six patients had Barrett's
esophagus, with or without severe dysplasia, 5 squamous cell cancer or early-stage
(uT1N0M0) adenocarcinoma, 1 advanced-stage (uT3N1) adenocarcinoma, and 1 patient a
lesion with an appearance that suggested esophageal cancer. Nine patients underwent
photodynamic diagnosis for follow-up after treatment of esophageal cancer with curative
intent; 6 had no macroscopically visible lesion and 3 a barely visible lesion under
standard (white-light) endoscopy. Photodynamic diagnosis was conducted 6 to 7 hours
after oral administration of ALA by using a special light source capable of delivering
either white or violet-blue light. Red fluorescence was detected with a charged coupled
device camera attached to a fiberoptic endoscope. Corresponding endoscopic, fluorescence,
and microscopic findings were compared. Results: By using histology as the reference standard (n = 86 biopsies), 85% of the biopsy
sites with premalignant or malignant histopathology exhibited red fluorescence, whereas
only 25% were detected with white-light endoscopy. Conclusion: ALA-induced fluorescence might be useful for the early endoscopic detection of malignant
esophageal lesions and follow-up after treatment of such lesions with curative intent.
(Gastrointest Endosc 2000;54:572-8.)
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Article info
Publication history
Accepted:
July 13,
2001
Received in revised form:
February 14,
2001
Received:
September 11,
2000
Footnotes
☆Supported by a grant from the J. and F. Marohn Foundation (Grant No. May/98).
☆☆Reprint requests: Brigitte Mayinger, MD, Department of Medicine I, University of Erlangen-Nuremberg, Krankenhausstraße 12, D-91054 Erlangen, Germany.
Identification
Copyright
© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
