Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett's esophagus

• Published in: Gastrointestinal endoscopy 2001-12, Vol.54 (6), p.682-688
• Main Authors: Buttar, Navtej S., Wang, Kenneth K., Lutzke, Lori S., Krishnadath, Krishnawatie K., Anderson, Marlys A.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Barrett Esophagus - drug therapy; Barrett Esophagus - mortality; Barrett Esophagus - pathology; Barrett Esophagus - surgery; Biological and medical sciences; Combined Modality Therapy; Disease-Free Survival; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagoscopy - methods; Esophagus; Female; Humans; Male; Medical sciences; Middle Aged; Mucous Membrane - pathology; Mucous Membrane - surgery; Photochemotherapy - methods; Prognosis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1067/gien.2001.0003

Background: Endoscopic mucosal resection (EMR) and photodynamic therapy have been proposed as treatments for early stage cancers. EMR is limited by its focal nature whereas photodynamic therapy is dependent on precise staging. The combination of EMR and photodynamic therapy were studied in the treatment of superficial cancer in patients with Barrett's esophagus. Methods: Seventeen consecutive nonsurgical patients with superficial cancers underwent EMR followed by photodynamic therapy with a porphyrin photosensitizer. Photoradiation was performed at 630 nm for a total dose of 200 J/cm of diffuser. Results: Seventeen patients (15 men; mean age 69 ± 13 years) underwent EMR. The mean diameter of mucosal resection was 1 cm. The margins were involved by cancer in 3 cases. EMR improved staging in 8 patients (47%). Sixteen (94%) patients remained in remission (median follow-up 13 months). Complications included minor bleeding after EMR in 1 patient (6%), stricture in 5 (30%), cutaneous phototoxicity in 2 (12%), and supraventricular tachycardia in 1 patient (6%). Conclusions: Combined EMR and photodynamic therapy appears to be an effective and safe therapy for superficial esophageal cancer within Barrett's esophagus. This combination improves cancer staging, removes the superficial cancer, and eliminates remaining mucosa at risk for cancer development. (Gastrointest Endosc 2001;54:682-8.)