Photodynamic therapy with porfimer sodium combined with acid suppression is used to treat patients with Barrett's esophagus with high-grade dysplasia.
Dr Mary Bronner and colleagues from Ohio, USA conducted a 5-year phase 3 trial to determine the extent of squamous overgrowth in patients with Barrett's esophagus with high-grade dysphasia.
The research team randomly assigned 138 patients to receive photodynamic therapy or 70 patients to 20 mg omeprazole twice daily.
|Squamous overgrowth did not obscure the most advanced neoplasia|
Patients underwent 4-quadrant jumbo esophageal biopsies every 2 cm throughout the pretreatment length of Barrett's esophagus.
The patients underwent the biopsies until 4 consecutive quarterly follow-up results were negative for high-grade dysphasia, and then biannually up to 5 years or treatment failure.
Endoscopies were reviewed by blinded gastroenterology pathologists.
The researchers found no significant difference in 33,658 biopsies in squamous overgrowth between groups when compared per patient or per biopsy.
The research team noted no difference when the average number of biopsies with squamous overgrowth were compared per patient.
The highest grade of neoplasia per endoscopy was not found exclusively beneath squamous mucosa in any patient.
Dr Bronner’s team concluded, “No difference was observed in squamous overgrowth between patients given photodynamic therapy plus omeprazole compared with only omeprazole.”
“Squamous overgrowth did not obscure the most advanced neoplasia in any patient.”
“Treatment of high-grade dysplasia with photodynamic therapy in patients with Barrett's esophagus does not present a long-term risk of failure to detect subsquamous dysplasia or carcinoma.”