Photodynamic therapy vs radiofrequency ablation for Barrett's dysplasia: efficacy, safety and cost-comparison.
OBJECTIVE
To compare effectiveness, safety, and cost of photodynamic therapy (PDT) and radiofrequency ablation (RFA) in treatment of Barrett's dysplasia (BD).


METHODS
Consecutive case series of patients undergoing either PDT or RFA treatment at single center by a single investigator were compared. Thirty-three patients with high-grade dysplasia (HGD) had treatment with porfimer sodium photosensitzer and 630 nm laser (130 J/cm), with maximum of 3 treatment sessions. Fifty-three patients with BD (47 with low-grade dysplasia -LGD, 6 with HGD) had step-wise circumferential and focal ablation using the HALO system with maximum of 4 treatment sessions. Both groups received proton pump inhibitors twice daily. Endoscopic biopsies were acquired at 2 and 12 mo after enrollment, with 4-quadrant biopsies every 1 cm of the original BE extent. A complete histological resolution response of BD (CR-D) was defined as all biopsies at the last endoscopy session negative for BD. Fisher's exact test was used to assess differences between the two study groups for primary outcomes. For all outcomes, a two-sided P value of less than 0.05 was considered to indicate statistical significance.


RESULTS
Thirty (91%) PDT patients and 39 (74%) RFA were men (P = 0.05). The mean age was 70.7 ± 12.2 and 65.4 ± 12.7 (P = 0.10) year and mean length of BE was 5.4 ± 3.2 cm and 5.7 ± 3.2 cm (P = 0.53) for PDT and RFA patients, respectively. The CR-D was (18/33) 54.5% with PDT vs (47/53) 88.7% with RFA (P = 0.001). One patient with PDT had an esophageal perforation and was managed with non-surgical measures and no perforation was seen with RFA. PDT was five times more costly than RFA at our institution. The two groups were not randomized and had different BD grading are the limitations of the study.


CONCLUSIONS
In our experience, RFA had higher rate of CR-D without any serious adverse events and was less costly than PDT for endoscopic treatment of BD.
Atilla Ertan, Nirav Thosani, Ertan Digestive Disease Center, Memorial Hermann Hospital, Texas Medical Center, Houston, TX 77030, United States.
Atilla
A
Ertan
Irum
I
Zaheer
Arlene M
AM
Correa
Nirav
N
Thosani
Shanda H
SH
Blackmon
D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D001706:Biopsy; D017115:Catheter Ablation / Q000009:adverse effects / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017323:Dihematoporphyrin Ether / Q000191:economics / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000009:adverse effects / Q000191:economics; D017319:Photosensitizing Agents / Q000191:economics / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000191:economics; D012189:Retrospective Studies; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome
D017319:Photosensitizing Agents; D054328:Proton Pump Inhibitors; D017323:Dihematoporphyrin Ether
Barrett’s esophagus; Cost comparison; Dysplasia; Photodynamic therapy; Radiofrequency ablation