Eradication of dysplastic Barrett's oesophagus using photodynamic therapy: long-term follow-up.
OBJECTIVE
Barrett's oesophagus is a major risk factor for oesophageal adenocarcinoma, a condition which is rapidly increasing in incidence. Photodynamic therapy (PDT) is a developing treatment in which tissue damage is caused by the action of light on a previously administered photosensitizing agent. We present the results of long-term follow-up of its efficacy in patients with dysplastic Barrett's oesophagus.


METHODS
A total of 40 patients with low-grade dysplasia in Barrett's oesophagus were treated with oral 5-aminolaevulinic acid (ALA) at a dose of 30 mg/kg, followed by laser endoscopy 4 hours later. Patients were treated between December 1995 and December 1998, and all were followed up regularly with endoscopy and biopsies in our surveillance programme.


RESULTS
Among the patients, 35 (88%) showed a macroscopic reduction in the area of the columnar epithelium, and in all 40 patients dysplasia was found to be eradicated at 1 month. The effect has been maintained for a median follow-up of 53 months (range 18-68 months), although one patient developed a late carcinoma in an untreated area of Barrett's oesophagus 3 years after the intervention.


CONCLUSIONS
Safe and effective ablation of low-grade dysplastic Barrett's oesophagus can be achieved with the use of ALA-induced PDT, and the effects are maintained in the long term.
Ackroyd
R
R
Department of Surgery, Sheffield Teaching Hospitals, Sheffield S10 2JF, UK. r.ackroyd@sheffield.ac.uk
Kelty
C J
CJ
Brown
N J
NJ
Stephenson
T J
TJ
Stoddard
C J
CJ
Reed
M W R
MW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D013997:Time Factors
D000897:Anti-Ulcer Agents; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; D009853:Omeprazole