Dr Bergman and colleagues conducted a study to prospectively evaluate endoscopic resection combined with photodynamic therapy for the treatment of selected patients with early neoplasia in Barrett's esophagus.
Patients with Barrett's esophagus and neoplastic lesions less than 2 cm in diameter and no sign of submucosal infiltration, positive lymph nodes, or distant metastasis underwent diagnostic endoscopic resection.
The investigators referred patients with a T1sm tumor (limited to the submucosa) in the resection specimen for surgery.
Those patients with a T1m tumor (limited to the mucosa) or a less invasive tumor underwent additional endoscopic therapy or were followed up.
The research team performed photodynamic therapy with 5-aminolevulinic acid and a light dose of 100 J/cm2 at 632 nm.
| At the end of follow-up, 93% of the endoscopically treated patients were in local remission|
The team undertook diagnostic endoscopic resection in 33 patients but not in 5 patients, who underwent surgery instead because 4 had T1sm and 1 patient preferred surgery.
5 patients were immediately entered into a follow-up protocol.
The researchers conducted additional endoscopic treatment in 23 patients where 13 received additional endoscopic resection, 19 had photodynamic therapy and 3 received argon plasma coagulation.
The investigators reported that endoscopic treatment was successful in 26 of 28 patients and that no severe complications were observed.
During a median follow-up of 19 months, 5 of the 26 patients had a recurrence of high-grade dysplasia and all were successfully re-treated with endoscopic resection.
In addition, the research team noted that at the end of follow-up, 79% of the originally enrolled patients and 93% of the endoscopically treated patients were in local remission.
Dr Bergman concludes, “Endoscopic therapy is safe and effective for selected patients with early stage neoplasia in Barrett's esophagus.”