Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett's esophagus.
BACKGROUND
The aim of this study was to prospectively evaluate endoscopic resection (ER) combined with photodynamic therapy (PDT) for the treatment of selected patients with early neoplasia in Barrett's esophagus.


METHODS
Patients with Barrett's esophagus and neoplastic lesions <2 cm in diameter and no sign of submucosal infiltration, positive lymph nodes, or distant metastasis underwent diagnostic ER (cap technique). Patients with a T1sm tumor in the resection specimen were referred for surgery; those with a T1m or a less invasive tumor underwent additional endoscopic therapy (ER, PDT, and/or argon plasma coagulation [APC]), or they were followed. PDT was performed with 5-aminolevulinic acid and a light dose of 100 J/cm 2 at lambda = 632 nm.


RESULTS
Thirty-three patients underwent diagnostic ER. Endoscopic treatment was not performed in 5 patients, who underwent surgery (4 T1sm; 1, patient preference). Five patients were immediately entered into a follow-up protocol, and 23 received additional endoscopic treatment (13 additional ER, 19 PDT, 3 APC). Endoscopic treatment was successful in 26/28 patients; no severe complication was observed. During follow-up (median 19 months, range 13-24 months), 5/26 patients had a recurrence of high-grade dysplasia: all were successfully re-treated with ER. At the end of follow-up, 26/33 originally enrolled patients (79%) and 26/28 endoscopically treated patients (93%) were in local remission.


CONCLUSIONS
Endoscopic therapy is safe and effective for selected patients with early stage neoplasia in Barrett's esophagus.
Peters
Femke P
FP
Department of Gastroenterology and Hepatology Laser Center, Amsterdam, The Netherlands.
Kara
Mohammed A
MA
Rosmolen
Wilda D
WD
Aalders
Maurice C G
MC
Ten Kate
Fiebo J W
FJ
Bultje
Bert C
BC
Krishnadath
Kausilia K
KK
Fockens
Paul
P
van Lanschot
Jan J B
JJ
van Deventer
Sander J H
SJ
Bergman
Jacques J G H M
JJ
D000368:Aged; D001128:Argon; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010778:Photochemotherapy; D011446:Prospective Studies; D016896:Treatment Outcome
D001128:Argon