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Photodynamic therapy for Barrett's esophagus
1Laser Department, Thompson Cancer Survival Center, Knoxville, Tennessee, USA.
Gastrointestinal Endoscopy Clinics of North America
|April 1, 1997
Summary
Photodynamic therapy (PDT) effectively treats Barrett's esophagus, eradicating dysplasia and reducing Barrett's mucosa extent. While strictures can occur, newer balloons minimize this risk, with long-term follow-up ongoing.
Area of Science:
- Gastroenterology
- Oncology
- Endoscopy
Background:
- Barrett's esophagus is a precancerous condition.
- Dysplasia in Barrett's esophagus increases cancer risk.
Purpose of the Study:
- To evaluate the efficacy of photodynamic therapy (PDT) for Barrett's esophagus with dysplasia.
- To assess the impact of PDT on superficial cancers and Barrett's mucosa.
Main Methods:
- Photodynamic therapy (PDT) with long-term omeprazole maintenance.
- Use of 5- and 7-cm centering balloons to reduce stricture formation.
- Lugol's staining and Nd:YAG laser therapy for residual Barrett's mucosa.
Main Results:
- Dysplasia eliminated in 42/55 patients; superficial cancers ablated in 7 patients.
- Complete elimination of Barrett's mucosa in 16 patients; reduction in all treated patients.
- Esophageal strictures occurred in 53% but were managed with dilation; newer balloons reduced incidence.
Conclusions:
- PDT, alone or with thermal ablation, can eliminate superficial cancers, dysplasia, and Barrett's mucosa.
- Longer PDT balloons show reduced mucosal injury and stricture formation.
- Ongoing monitoring is crucial for long-term outcomes and dysplasia management.