Photodynamic therapy in Barrett's esophagus: results of treatment of 17 patients

Barrett's esophagus (BE) with dysplasia may progress to esophageal adenocarcinoma. Photodynamic therapy is a promising treatment for BE. To determine if photodynamic therapy is an acceptable alternative to esophagectomy in BE patients with high-grade dysplasia or early adenocarcinoma. Seventeen...

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Bibliographic Details
Published in:Canadian journal of gastroenterology 2006-04, Vol.20 (4), p.261-264
Main Authors: Weiss, Alan A, Wiesinger, Holly A R, Owen, David
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - prevention & control
Aged
Aged, 80 and over
Barrett Esophagus - drug therapy
Barrett Esophagus - pathology
Dihematoporphyrin Ether - therapeutic use
Endoscopy, Gastrointestinal
Esophageal Neoplasms - pathology
Esophageal Neoplasms - prevention & control
Female
Follow-Up Studies
Humans
Male
Middle Aged
Original
Photochemotherapy
Photosensitizing Agents - therapeutic use
Precancerous Conditions
Retrospective Studies
Treatment Outcome
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Summary:Barrett's esophagus (BE) with dysplasia may progress to esophageal adenocarcinoma. Photodynamic therapy is a promising treatment for BE. To determine if photodynamic therapy is an acceptable alternative to esophagectomy in BE patients with high-grade dysplasia or early adenocarcinoma. Seventeen patients were treated with photodynamic therapy for BE and high-grade dysplasia or early esophageal adenocarcinoma. Patients with residual Barrett's epithelium were treated with supplemental argon plasma coagulation or potassium titanyl phosphate laser. Patients underwent follow-up endoscopy three, six, nine and 12 months post-treatment, then every six to 12 months. Mean follow-up was 21 months. High-grade dysplasia or early adenocarcinoma was completely eliminated in nine of 15 (60%) patients. High-grade dysplasia was downgraded in one patient, persisted in one patient and progressed in four patients. Two patients with early esophageal adenocarcinoma were nonresponders. Complications included stricture, sunburn, urticaria, small pleural effusions, esophageal spasm and transient atrial fibrillation. Photodynamic therapy with supplemental ablation is a good, noninvasive therapy for elimination of high-grade dysplasia and early adenocarcinoma in BE. Failure to eliminate dysplastic epithelium occurred in 40% of the patients, thereby necessitating careful follow-up.
ISSN:0835-7900
DOI:10.1155/2006/954153