title: Invasive carcinoma after endoscopic ablative therapy for high-grade dysplasia in Barrett's oesophagus.
abstract: BACKGROUND
  Patients with high-grade dysplasia (HGD) in Barrett's oesophagus carry a significant risk of developing adenocarcinoma. Endoscopic mucosal resection (EMR) and photodynamic therapy (PDT) aim at the radical ablation of the dysplastic area.
  
  
  METHODS
  We used EMR to resect the macroscopic area of dysplastic mucosa followed by PDT to eliminate residual disease. PDT was performed after oral administration of 5-aminolevulinic acid (ALA, 40 mg/kg), using fractionated illumination 3 and 6 h later with 630 nm light at 100 J/cm(2) through an endoscopic balloon diffuser.
  
  
  RESULTS
  We report 2 patients who developed adenocarcinoma shortly after incomplete endoscopic ablation of Barrett's epithelium. In a 61-year-old man with HGD in 8-cm Barrett's segment, HGD persisted 3 months after treatment. The oesophagectomy specimen showed a 2.3-cm pT2N0M0 adenocarcinoma in Barrett's. In a 69-year-old woman with extensive HGD in 5-cm Barrett's, HGD persisted after 3 PDT sessions in 1 year. Adenocarcinoma occurred 6 months after treatment. The oesophagectomy showed a pT1bN0M0 adenocarcinoma and extensive multifocal HGD in Barrett's.
  
  
  CONCLUSIONS
  The combination of EMR and PDT may be a promising option for local treatment of patients with HGD in Barrett's oesophagus, provided all dysplastic tissue can be removed. Currently it should be offered only to patients who are willing to participate in a clinical trial with an intensive endoscopic follow-up programme.
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. r.vanhillegersberg@12move.nl
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
authors.forename: Jelle
authors.initials: J
authors.lastname: Haringsma
authors.forename: Fibo J W
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: Guido N J
authors.initials: GN
authors.lastname: Tytgat
authors.forename: Jan J B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010778:Photochemotherapy