Photodynamic therapy can eliminate Barrett's dysplasia.
In this study, a team of researchers from the United States report the long-term follow-up of patients with Barrett's esophagus who were treated with photodynamic therapy.
Patients had high-grade dysplasia, low-grade dysplasia, or early stage carcinoma.
Porfimer-photodynamic therapy was performed in 103 patients. The Nd:YAG laser was used to photoablate small areas of residual or untreated Barrett's mucosa.
The team maintained acid suppression with omeprazole (20mg twice a day) in all patients.
The mean follow-up period was 50.65 months.
|The mean decrease in the length of Barrett's mucosa after photodynamic therapy was 6.92 cm.|
However, for the 82 patients who were not lost to follow-up, mean follow-up was 58.5 months.
The researchers found that the mean decrease in the length of Barrett's mucosa after photodynamic therapy was 6.92 cm.
Of the 65 patients with high-grade dysplasia, 94% had elimination of high-grade dysplasia.
Only 5% of patients developed subsquamous adenocarcinoma.
The team found subsquamous, nondysplastic, metaplastic epithelium in 5%.
They found that after 1 session of photodynamic therapy strictures occurred in 18% of patients. After 2 sessions they occurred in 50%.
The team determined that intention-to-treat success rates were 93% for low-grade dysplasia, 78% for high-grade dysplasia, and 44% for early stage carcinoma.
Dr Bergein Overholt's team concluded, "Porfimer-photodynamic therapy with supplemental Nd:YAG photoablation and continuous treatment with omeprazole reduces the length of Barrett's mucosa".
It also, "Eliminates high-grade dysplasia, and, by comparison with historical data, may reduce the expected frequency of carcinoma".