Barrett's esophagus: photodynamic therapy for ablation of dysplasia, reduction of specialized mucosa, and treatment of superficial esophageal cancer,☆☆,

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MATERIALS AND METHODS

All patients referred for PDT had repeated endoscopic examinations and biopsies demonstrating Barrett's esophagus and dysplasia. Pretreatment four-quadrant biopsy specimens were obtained at 2 cm levels in Barrett's mucosa. One patient had a villous adenoma and four had early cancers less than 1.5 cm in size (Table 1). In patients with biopsy-proven adenocarcinomas, only those with lesions that were interpreted Tis-1, N0, M016 by endoscopic ultrasound and CT were included in the study. However,

RESULTS

With the nonballoon system, extensive injury to exposed mucosa was observed along with destruction of dysplastic epithelium and small cancers. However, there were occasional small areas of mucosa that were not damaged. In the first two patients (case 2 and 3) treated with 300 J/cm using the balloon system,20 marked circumferential edema, superficial ulceration, and mucosal hemorrhage were found. Therefore, the energy density was reduced to 250 J/cm in patient 6 and 200 J/cm in patient 7 to

DISCUSSION

Barrett's esophagus1, 2 is characterized by replacement of normal esophageal squamous epithelium by specialized columnar epithelium. The incidence of carcinoma in Barrett's esophagus has been reported to be 30 to 40 times that of the normal population,3, 4, 5, 6 occurring in approximately 10% of cases.7, 8, 9 Annual or biennial screening endoscopy with multiple biopsies has been recommended for detection of dysplasia or early adenocarcinoma. Esophagectomy has been recommended for Barrett's

Acknowledgements

The authors acknowledge the significant contributions to this work provided by Elmeria Teffetellar, RN, Rick Sneed, Mark Rose, and Paul Buckley.

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      A variety of photosensitizing agents are available. Porfimer sodium, first reported as a treatment for BE with HGD and early cancer in 1993, has been shown to effectively eliminate HGD.56,85-88 Initially developed as hematoporphyrin derivative, the drug was later refined as sodium porfimer (Photofrin II; Sanofi Winthrop, Sanofi-Aventis Pharmaceuticals, Bridgewater.

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    Financial support was provided by the Thompson Charitable Trust and the Thompson Cancer Survival Center.

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    Reprint requests: Bergein F. Overholt, MD, P.O. Box 59002, Knoxville, TN 37950-9002.

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