Endoscopic mucosal ablation is a promising technique that is used to treat dysplastic Barrett's esophagus.
Dr Krish Ragunath and colleagues from England investigated efficacy and cost-effectiveness of ablation techniques of dysplastic Barrett's esophagus.
The research team compared 2 of these techniques; argon plasma coagulation and photodynamic therapy.
The team included 26 patients with dysplastic Barrett's esophagus, of which 21 were male with a median age of 60 years.
Of these patients, 23 had low-grade dysplasia, and 3 had high-grade dysplasia.
The researchers randomized 13 patients to argon plasma coagulation and 13 to photodynamic therapy.
|Barrett's eradicated at 4-month follow-up with photodynamic therapy was 57%|
|Scandanavian Journal of Gastroenterology|
The team performed argon plasma coagulation at a power setting of 65 W and argon gas flow at 1.8 /min in 1 to 6 sessions.
Photodynamic therapy was performed 48 hours after intravenous injection of photofrin 2 mg/kg with a 630 nm red laser light, 200 J/cm through a balloon in 1 session.
All patients received treatment with high-dose proton pump inhibitors.
The researchers undertook cost analysis and the results were assessed by endoscopy and biopsies at 4 months and 12 months after therapy.
The team observed a reduction in the length of Barrett's esophagus in all patients in both groups.
The researchers found that the median length of Barrett's esophagus eradicated at the 4-month follow-up was 65% with argon plasma coagulation.
The median length of Barrett's esophagus eradicated at the 4-month follow-up with photodynamic therapy was 57%.
At the 12-month follow-up, the team found that the median length of Barrett's esophagus eradicated by argon plasma coagulation was 56%.
The researchers also found that the median length of Barrett's esophagus eradicated by photodynamic therapy was 60%.
Dysplasia eradication at 4 months with argon plasma coagulation was 62% and 77% with photodynamic theray.
At 12 months, the team noted that dysplasia eradication with argon plasma coagulation was 67% vs 77% with photodynamic therapy.
Buried columnar glands with intestinal metaplasia were seen in both groups.
The team observed that 1 patient in the photodynamic therapy arm developed adenocarcioma under the neo-squamous epithelium.
Severe adverse events included chest pain and fever in 15%, and 8% with odynophagia using argon plasma coagulation.
The researchers noted that photosensitivity occurred in 15% with photodynamic therapy and 15% with stricture in photodynamic therapy.
The team reported that photodynamic therapy would cost an additional £266 for every percentage reduction in Barrett's length.
In addition, the researchers found that photodynamic therapy costs a further £146 per percentage reduction in dysplasia compared with argon plasma coagulation.
Dr Ragunath's team concludes, “Argon plasma coagulation and photodynamic therapy are equally effective in eradicating Barrett's mucosa.”
"Photodynamic therapy is the more expensive treatment.”
“However, photodynamic therapy is more effective in eradicating dysplasia and the extra benefits are generated at an extra cost.”
“The occurrence of buried columnar glands and carcinoma warrants caution.”
“Long-term follow-up is needed to assess cancer prevention and the durability of the neo-squamous epithelium to justify these interventions.”