Neodymium:yttrium-aluminum garnet contact laser ablation of Barrett's high grade dysplasia and early adenocarcinoma.
OBJECTIVE
We describe the efficacy and safety of neodymium:yttrium-aluminum garnet (Nd:YAG) contact laser ablation of Barrett's high grade dysplasia (HGD) and/or early adenocarcinoma.


METHODS
Consecutive Barrett's patients in whom HGD or adenocarcinoma was detected were eligible. Radial array echoendosonography and high frequency catheter probe ultrasonography were performed. Patients were excluded if ultrasound revealed the presence of Barrett's cancer with regional lymph nodes or celiac trunk metastases or extension of the tumor into superficial submucosa (T1sm1) or greater. Nd:YAG laser used quartz contact probes, with all Barrett's epithelium targeted at each session. Complete ablation was confirmed with Lugol's iodine chromoendoscopy followed by surveillance biopsies of the neosquamous epithelium. Adverse events were ascertained by scheduled telephone contact interviews.


RESULTS
A total of 36 patients with HGD/adenocarcinoma were evaluated at our center, 17 of whom met all inclusion criteria. Of the patients, 14 have remained in the study, and all have had successful elimination of HGD and cancer. In addition, 11 patients (78.6%) achieved complete endoscopic and histological ablation of all Barrett's tissue. Two patients (14.3%) achieved 95% destruction of Barrett's with residual metaplastic columnar epithelium containing goblet cells without dysplasia. The remaining patient has obtained 75% ablation of Barrett's, with residual metaplastic columnar epithelium harboring Barrett's with low grade dysplasia. Major complications included two esophageal strictures (11.8%) and one mild upper GI bleed (5.9%).


CONCLUSIONS
This preliminary experience with Nd:YAG contact laser for the treatment of Barrett's HGD and early superficial cancers seems promising. The need for additional controlled trials with larger numbers of patients with longer follow-up, as well as consideration of a head-to-head trial with Photofrin photodynamic therapy, is warranted.
Weston
Allan P
AP
Specialty Care Section, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri 64128, USA.
Sharma
Prateek
P
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000535:Aluminum; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D004938:Esophageal Neoplasms / Q000601:surgery*; D004945:Esophagoscopy; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009354:Neodymium; D015019:Yttrium
D009354:Neodymium; D015019:Yttrium; D000535:Aluminum