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


METHODS
Forty-five (45) patients with Barrett's esophagus and dysplasia were treated with photodynamic therapy using sodium porfimer 2.0 mg/kg as the photosensitizing drug. Fifteen patients also had 16 superficial esophageal cancers (0-1.5 cm; Tis-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 following photodynamic therapy.


RESULTS
Photodynamic therapy produced 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 found in 16 patients. Areas of dysplasia were eliminated in 35 of the 45 patients. All 16 malignancies were ablated. No cancer recurrence was found in follow-up. Healing was associated with esophageal strictures in 58%, which were treated successfully by esophageal dilation in all patients.


CONCLUSIONS
Photodynamic therapy combined with long-term acid inhibition provides an effective endoscopic therapy to (1) eliminate Barrett's mucosal dysplasia and superficial esophageal cancer and (2) reduce the amount of and, in some cases, eliminate Barrett's mucosa.
Overholt
B F
BF
Laser Center, Thompson Cancer Survival Center, Knoxville, Tennessee 37916, USA.
Panjehpour
M
M
D000230:Adenocarcinoma / Q000188:drug therapy; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001128:Argon; D001471:Barrett Esophagus / Q000188:drug therapy*; D017323:Dihematoporphyrin Ether / Q000008:administration & dosage / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000188:drug therapy; D005500:Follow-Up Studies; D006414:Hematoporphyrin Photoradiation / Q000009:adverse effects; D006801:Humans; D053685:Laser Therapy; D009092:Mucous Membrane / Q000293:injuries; D009354:Neodymium; D017063:Outcome Assessment, Health Care; D012008:Recurrence
D000970:Antineoplastic Agents; D009354:Neodymium; D001128:Argon; D017323:Dihematoporphyrin Ether