Eradication of Dysplastic Barrett’s Oesophagus Using Photodynamic Therapy: Long-Term Follow-Up

 

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Background and Study Aims: Barrett’s oesophagus is a major risk factor for oesophageal adenocarcinoma, a condition which is rapidly increasing in incidence. Photodynamic therapy (PDT) is a developing treatment in which tissue damage is caused by the action of light on a previously administered photosensitizing agent. We present the results of long-term follow-up of its efficacy in patients with dysplastic Barrett’s oesophagus.
Patients and Methods: A total of 40 patients with low-grade dysplasia in Barrett’s oesophagus were treated with oral 5-aminolaevulinic acid (ALA) at a dose of 30 mg/kg, followed by laser endoscopy 4 hours later. Patients were treated between December 1995 and December 1998, and all were followed up regularly with endoscopy and biopsies in our surveillance programme.

Results: Among the patients, 35 (88 %) showed a macroscopic reduction in the area of the columnar epithelium, and in all 40 patients dysplasia was found to be eradicated at 1 month. The effect has been maintained for a median follow-up of 53 months (range 18 - 68 months), although one patient developed a late carcinoma in an untreated area of Barrett’s oesophagus 3 years after the intervention.
Conclusions: Safe and effective ablation of low-grade dysplastic Barrett’s oesophagus can be achieved with the use of ALA-induced PDT, and the effects are maintained in the long term.

References

• 1 Devesa S S, Blot W J Jr., Fraumeni J F. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States.  Cancer. 1998;  83 2049-2053
  CrossrefPubMedGoogle Scholar
• 2 Haggitt R C. Barrett’s esophagus, dysplasia, and adenocarcinoma.  Hum Pathol. 1994;  25 982-993
  CrossrefPubMedGoogle Scholar
• 3 Gillen P, Keeling P, Byrne P J. et al . Experimental columnar metaplasia in the canine oesophagus.  Br J Surg. 1988;  75 113-115
  CrossrefPubMedGoogle Scholar
• 4 Falk G W. Reflux disease and Barrett’s esophagus.  Endoscopy. 1999;  31 9-16
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Williamson W A, Ellis F H Jr., Gibb S P. et al . Barrett’s oesophagus. Prevalence and incidence of adenocarcinoma.  Arch Intern Med. 1991;  151 2212-2216
  CrossrefPubMedGoogle Scholar
• 6 Sjogren R W, Johnson L F. Barrett’s esophagus: a review.  Am J Med. 1983;  74 313-321
  CrossrefPubMedGoogle Scholar
• 7 Hameeteman W, Tytgat G N, Houthoff H J. et al . Barrett’s esophagus: development of dysplasia and adenocarcinoma.  Gastroenterology. 1989;  96 1249-1256
  PubMedGoogle Scholar
• 8 Miros M, Kerlin P, Walker N. Only patients with dysplasia progress to adenocarcinoma in Barrett’s oesophagus.  Gut. 1991;  32 1441-1446
  PubMedGoogle Scholar
• 9 Cameron A J, Ott B J, Payne W S. The incidence of adenocarcinoma in columnar-lined (Barrett’s) esophagus.  N Engl J Med. 1985;  313 857-859
  CrossrefPubMedGoogle Scholar
• 10 Drewitz D J, Sampliner R E, Garewal H S. The incidence of adenocarcinoma in Barrett’s esophagus: a prospective study of 170 patients followed 4.8 years.  Am J Gastroenterol. 1997;  92 212-215
  PubMedGoogle Scholar
• 11 Rice T W, Falk G W, Achkar E. et al . Surgical management of high-grade dysplasia in Barrett’s esophagus.  Am J Gastroenterol. 1993;  88 1832-1836
  PubMedGoogle Scholar
• 12 van Sandick J W, van Lanschot J JB, Kuiken B W. et al . Impact of endoscopic biopsy surveillance of Barrett’s oesophagus on pathological stage and clinical outcome of Barrett’s carcinoma.  Gut. 1998;  43 216-222
  CrossrefPubMedGoogle Scholar
• 13 Sampliner R E. Ablative therapies for the columnar-lined esophagus.  Gastroenterol Clin N Am. 1997;  26 685-694
  PubMedGoogle Scholar
• 14 Barham C P, Jones R L, Biddlestone L R. et al . Photothermal laser ablation of Barrett’s oesophagus: endoscopic and histological evidence of squamous re-epithelialisation.  Gut. 1997;  41 281-284
  CrossrefPubMedGoogle Scholar
• 15 Morris C D, Byrne J P, Armstrong G R. et al . Prevention of the neoplastic progression of Barrett’s oesophagus by endoscopic argon beam plasma ablation.  Br J Surg. 2001;  88 1357-1362
  CrossrefPubMedGoogle Scholar
• 16 Pereira-Lima J C, Busnello J V, Saul C. et al . High power setting argon plasma coagulation for the eradication of Barrett’s esophagus.  Am J Gastroenterol. 2000;  95 1661-1668
  PubMedGoogle Scholar
• 17 Endo M. Endoscopic resection as local treatment of mucosal cancer of the esophagus.  Endoscopy. 1993;  25 672-674
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Overholt B F, Panjehpour M, Haydek J M. Photodynamic therapy for Barrett’s esophagus: follow-up in 100 patients.  Gastrointest Endosc. 1999;  49 1-7
  CrossrefPubMedGoogle Scholar
• 19 Gossner L, May A, Sroka R. et al . Photodynamic destruction of high grade dysplasia and early carcinoma of the esophagus after the oral administration of 5-aminolevulinic acid.  Cancer. 1999;  86 1921-1928
  CrossrefPubMedGoogle Scholar
• 20 Ackroyd R, Brown N J, Davis M F. et al . Photodynamic therapy for Barrett’s oesophagus: a prospective randomised placebo-controlled trial.  Gut. 2000;  47 612-617
  CrossrefPubMedGoogle Scholar
• 21 Ackroyd R, Brown N, Vernon D. et al . 5-Aminolevulinic acid photosensitization of dysplastic Barrett’s esophagus: a pharmacokinetic study.  Photochem Photobiol. 1999;  70 656-662
  CrossrefPubMedGoogle Scholar
• 22 Ackroyd R, Brown N J, Davis M F. et al . Aminolevulinic acid-induced photodynamic therapy: safe and effective ablation of dysplasia in Barrett’s esophagus.  Dis Esoph. 2000;  13 18-22
  PubMedGoogle Scholar
• 23 Barr H, Shepherd N A, Dix A. et al . Eradication of high-grade dysplasia in columnar-lined (Barrett’s) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX.  Lancet. 1996;  348 584-585
  CrossrefPubMedGoogle Scholar
• 24 Tan W C, Fulljames C, Stone N. et al . Photodynamic therapy using 5-aminolaevulinic acid for oesophageal adenocarcinoma associated with Barrett’s metaplasia.  J Photochem Photobiol B. 1999;  53 75-80
  CrossrefPubMedGoogle Scholar
• 25 Tajiri H, Daikuzono N, Joffe S N. et al . Photoradiation therapy in early gastrointestinal cancer.  Gastrointest Endosc. 1987;  33 88-90
  PubMedGoogle Scholar
• 26 Regula J, MacRobert A J, Gorchein A. et al . Photosensitisation and photodynamic therapy of oesophageal, duodenal, and colorectal tumours using 5 aminolaevulinic acid induced protoporphyrin IX - a pilot study.  Gut. 1995;  36 67-75
  PubMedGoogle Scholar
• 27 Loh C S, MacRobert A J, Buonaccorsi G. et al . Mucosal ablation using photodynamic therapy for the treatment of dysplasia: an experimental study in the normal rat stomach.  Gut. 1996;  38 71-78
  CrossrefPubMedGoogle Scholar
• 28 Ackroyd R, Brown N J, Stephenson T J. et al . Ablation treatment for Barrett oesophagus: what depth of tissue destruction is needed?.  J Clin Pathol. 1999;  52 509-512
  CrossrefPubMedGoogle Scholar
• 29 Barr H, Tralau C J, Boulos P B. et al . The contrasting mechanisms of colonic collagen damage between photodynamic therapy and thermal injury.  Photochem Photobiol. 1987;  46 795-800
  PubMedGoogle Scholar
• 30 Kennedy J C, Pottier R H. Endogenous protoporphyrin IX, a clinically useful photosensitizer for photodynamic therapy.  J Photochem Photobiol B. 1992;  14 275-292
  CrossrefPubMedGoogle Scholar
• 31 Gossner L, Stolte M, Sroka R. et al . Photodynamic ablation of high-grade dysplasia and early cancer in Barrett’s esophagus by means of 5-aminolevulinic acid.  Gastroenterology. 1998;  114 448-455
  PubMedGoogle Scholar
• 32 Van Laethem J L, Peny M O, Salmon I. et al . Intramucosal adencarcinoma arising under squamous re-epithelialisation of Barrett’s oesophagus.  Gut. 2000;  46 574-577
  CrossrefPubMedGoogle Scholar
• 33 Kelty C J, Ackroyd R. Re-epithelialisation of Barrett’s oesophagus.  Gut. 2000;  47 741
  CrossrefPubMedGoogle Scholar
• 34 Riddell R H, Goldman H, Ransohoff D F. et al . Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications.  Hum Pathol. 1983;  14 931-968
  PubMedGoogle Scholar
• 35 Ackroyd R, Roberts D JH, Vernon D I. et al . Photodynamic therapy (PDT) for Barrett’s oesophagus: a dosimetric pilot study.  Br J Surg. 1996;  83 1637
  PubMedGoogle Scholar
• 36 Sampliner R E, Hixson L J, Fennerty M B. et al . Regression of Barrett’s oesophagus by laser ablation in an anacid environment.  Dig Dis Sci. 1993;  38 365-368
  CrossrefPubMedGoogle Scholar
• 37 Overholt B F, Panjehpour M, Tefftellar E. et al . Photodynamic therapy for treatment of early adenocarcinoma in Barrett’s esophagus.  Gastrointest Endosc. 1993;  39 73-76
  PubMedGoogle Scholar
• 38 Grant W E, Hopper C, MacRobert A J. et al . Photodynamic therapy of oral cancer: photosensitisation with systemic aminolaevulinic acid.  Lancet. 1993;  342 147-148
  CrossrefPubMedGoogle Scholar
• 39 Levine D S, Haggitt R C, Blount P L. et al . An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett’s esophagus.  Gastroenterology. 1993;  105 40-50
  CrossrefPubMedGoogle Scholar
• 40 Fass R, Sampliner R E, Malagon I B. et al . Failure of oesophageal acid control in candidates for Barrett’s oesophagus reversal on a very high dose of proton pump inhibitor.  Aliment Pharmacol Ther. 2000;  14 597-602
  CrossrefPubMedGoogle Scholar

R. Ackroyd, M.D.

Department of Surgery, K Floor

Royal Hallamshire Hospital · Glossop Road · Sheffield, S10 2JF · UK

Fax: + 44-114-2713791

Email: r.ackroyd@sheffield.ac.uk