Eradication of dysplastic Barrett's oesophagus using photodynamic therapy: long-term follow-up

• Published in: Endoscopy Vol. 35; no. 6; p. 496
• Main Authors: Ackroyd, R, Kelty, C J, Brown, N J, Stephenson, T J, Stoddard, C J, Reed, M W R
• Format: Journal Article
• Language: English
• Published: Germany 01.06.2003
• Subjects: Adult; Aged; Aged, 80 and over; Aminolevulinic Acid - therapeutic use; Anti-Ulcer Agents - therapeutic use; Barrett Esophagus - drug therapy; Barrett Esophagus - pathology; Esophagoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Omeprazole - therapeutic use; Photochemotherapy; Photosensitizing Agents - therapeutic use; Time Factors
• ISSN: 0013-726X
• DOI: 10.1055/s-2003-39676

Barrett's oesophagus is a major risk factor for oesophageal adenocarcinoma, a condition which is rapidly increasing in incidence. Photodynamic therapy (PDT) is a developing treatment in which tissue damage is caused by the action of light on a previously administered photosensitizing agent. We present the results of long-term follow-up of its efficacy in patients with dysplastic Barrett's oesophagus. A total of 40 patients with low-grade dysplasia in Barrett's oesophagus were treated with oral 5-aminolaevulinic acid (ALA) at a dose of 30 mg/kg, followed by laser endoscopy 4 hours later. Patients were treated between December 1995 and December 1998, and all were followed up regularly with endoscopy and biopsies in our surveillance programme. Among the patients, 35 (88%) showed a macroscopic reduction in the area of the columnar epithelium, and in all 40 patients dysplasia was found to be eradicated at 1 month. The effect has been maintained for a median follow-up of 53 months (range 18-68 months), although one patient developed a late carcinoma in an untreated area of Barrett's oesophagus 3 years after the intervention. Safe and effective ablation of low-grade dysplastic Barrett's oesophagus can be achieved with the use of ALA-induced PDT, and the effects are maintained in the long term.