Squamous overgrowth is not a safety concern for photodynamic therapy for Barrett's esophagus with high-grade dysplasia.
OBJECTIVE
Photodynamic therapy with porfimer sodium combined with acid suppression (PHOPDT) is used to treat patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD). A 5-year phase 3 trial was conducted to determine the extent of squamous overgrowth of BE with HGD after PHOPDT.


METHODS
Squamous overgrowth was compared in patients with BE with HGD randomly assigned (2:1) to receive PHOPDT (n=138) or 20 mg omeprazole twice daily (n=70). Patients underwent 4-quadrant jumbo esophageal biopsies every 2 cm throughout the pretreatment length of BE until 4 consecutive quarterly follow-up results were negative for HGD and then biannually up to 5 years or treatment failure. Endoscopies were reviewed by blinded gastroenterology pathologists.


RESULTS
Histologic assessment of 33,658 biopsies showed no significant difference (P> .05) in squamous overgrowth between groups when compared per patient (30% vs 33%) or per biopsy (0.5% vs 1.3%), or when the average number of biopsies with squamous overgrowth were compared per patient (0.48 vs 0.66). The highest grade of neoplasia per endoscopy was not found exclusively beneath squamous mucosa in any patient.


CONCLUSIONS
No difference was observed in squamous overgrowth between patients given PHOPDT plus omeprazole compared with only omeprazole. Squamous overgrowth did not obscure the most advanced neoplasia in any patient. Treatment of HGD with PHOPDT in patients with BE does not present a long-term risk of failure to detect subsquamous dysplasia or carcinoma.
Bronner
Mary P
MP
Cleveland Clinic, Cleveland, Ohio 44195, USA. bronnem@ccf.org
Overholt
Bergein F
BF
Taylor
Shari L
SL
Haggitt
Rodger C
RC
Wang
Kenneth K
KK
Burdick
J Steven
JS
Lightdale
Charles J
CJ
Kimmey
Michael
M
Nava
Hector R
HR
Sivak
Michael V
MV
Nishioka
Norman
N
Barr
Hugh
H
Canto
Marcia I
MI
Marcon
Norman
N
Pedrosa
Marcos
M
Grace
Michael
M
Depot
Michelle
M
D000368:Aged; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology; D001706:Biopsy; D017323:Dihematoporphyrin Ether / Q000627:therapeutic use; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010778:Photochemotherapy / Q000009:adverse effects*
D017323:Dihematoporphyrin Ether; D009853:Omeprazole