Photodynamic therapy for Barrett's esophagus: clinical update

This report presents clinical results of photodynamic therapy for dysplasia and superficial esophageal cancer in Barrett's esophagus.

Thirty-six patients with Barrett's esophagus and dysplasia were treated with photodynamic therapy, and sodium porfimer 2.0 mg/kg was used as the photosensitizing drug. Fourteen patients also had 15 superficial esophageal cancers (0-1.5 cm; ultrasound-T2,N-0,M-0). Red light (630 nm) was delivered to the esophageal mucosa by a diffuser inserted through the endoscope or via a windowed esophageal centering balloon designed to improve targeted delivery of light during photodynamic therapy. Patients were maintained on omeprazole and were followed for 6-62 months after photodynamic therapy.

Photodynamic therapy produced extensive mucosal damage in treated areas. Ablation of dysplastic or malignant mucosa was followed by healing and conversion of approximately 75-80% of treated Barrett's mucosa to normal squamous epithelium in all patients. Complete elimination of Barrett's epithelium was achieved in 10 patients. Areas of dysplasia were eliminated in 29 patients, and all 15 malignancies were ablated. No cancer recurrence was found in follow-up. Healing was associated with esophageal strictures (four were severe) that were treated successfully by esophageal dilation in 21 patients.

Photodynamic therapy combined with long-term acid inhibition provides effective endoscopic therapy that 1) eliminates Barrett's mucosal dysplasia and superficial esophageal cancer, and 2) reduces the amount of, or, in some cases, eliminates Barrett's mucosa.