A protease-activated, near-infrared fluorescent probe for early endoscopic detection of premalignant gastrointestinal lesions

Significance Early detection by white-light endoscopy (WLE) is the key procedure used in clinical care to prevent colorectal cancer (CRC). In high-risk patients to develop CRC, like in inflammatory bowel disease, the miss-rate of dysplastic lesions is three times higher compared to healthy individuals. In this study we explored the use of a near-infrared probe with fluorescence endoscopy as an adjunct to WLE to highlight adenomas. We demonstrated in clinically relevant animal models of colorectal carcinogenesis and ulcerative colitis that our strategy enabled improved detection using near-infrared fluorescence-guided colonoscopy without interfering in the clinical workflow. Since combined near-infrared fluorescent/WLE systems are already being clinically translated, our approach could result in improving the adenoma detection rate during colonoscopy particularly in high-risk patients.