Barrett's esophagus: photodynamic therapy for ablation of dysplasia, reduction of specialized mucosa, and treatment of superficial esophageal cancer☆,☆☆,★
Section snippets
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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Cited by (102)
The Society of Thoracic Surgeons Practice Guideline Series: Guidelines for the Management of Barrett's Esophagus With High-Grade Dysplasia
2009, Annals of Thoracic SurgeryCitation Excerpt :Several trials have assessed the effectiveness of PDT alone for HGD. Most such trials involve relatively small patient numbers with only short-term to medium-term follow-up [29–34]. Trials demonstrating the effectiveness of PDT at reducing the development of cancer beyond 5 years are lacking.
Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett's high-grade dysplasia
2007, Gastrointestinal EndoscopyEndoscopic Therapy of Dysplasia and Early-Stage Cancers of the Esophagus
2007, Seminars in Radiation OncologyCitation Excerpt :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.
Endoscopic therapy for Barrett's esophagus
2005, Gastrointestinal Endoscopy Clinics of North AmericaVisible endoscopic and histologic changes in the cardia, before and after complete Barrett's esophagus ablation
2005, Gastrointestinal Endoscopy
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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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37/69/62263