In this study, doctors from the Netherlands compared 5-aminolevulinic acid induced photodynamic therapy (ALA-PDT) and argon plasma coagulation (APC) for the treatment of Barrett's esophagus (BE).
The team randomized 40 patients with BE to one of 3 treatments:
- ALA-PDT as a single dose of 100 J/cm2 at 4 hours (PDT100).
- ALA-PDT as a fractionated dose of 20 and 100 J/cm2 at 1 and 4 hours, respectively (PDT20+100).
- APC at a power setting of 65 W in 2 sessions (APC).
If the complete elimination of BE did not occur the patient received an additional 1 to 2 sessions of APC.
The team found that the mean endoscopic reduction of BE at 6 weeks was 51% in the PDT100 group, 86% in the PDT20+100 group, and 93% in the APC group.
|Pain, and nausea and vomiting was more frequent after photodynamic therapy.|
They found that histologically complete ablation occurred in 8% of patients in the PDT100 group, 33% in the PDT20+100 group, and 36% in the APC group.
Remaining BE was treated in 23 patients with APC.
The team found that a histological examination at 12 months revealed complete ablation in 82% of the PDT100 group, 90% of the PDT20+100 group, and in 67% of the APC group. At 12 months, no dysplasia was detected.
Pain, and nausea and vomiting, and elevated liver transaminases occurred more frequently following photodynamic therapy than APC.
Dr Hage and colleagues concluded, "APC alone or ALA-PDT in combination with APC can lead to complete reversal of Barrett’s epithelium in at least two thirds of patients when administered in multiple treatment sessions".
"As the goal of treatment should be complete reversal of Barrett’s epithelium, we do not recommend these techniques for the prophylactic ablation of BE".