Endoscopic ablation of Barrett's oesophagus: a randomized‐controlled trial of photodynamic therapy vs. argon plasma coagulation

• Published in: Alimentary pharmacology & therapeutics Vol. 20; no. 11‐12; pp. 1289 - 1296
• Main Authors: Kelty, C. J., Ackroyd, R., Brown, N. J., Stephenson, T. J., Stoddard, C. J., Reed, M. W. R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.12.2004; Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Aminolevulinic Acid - adverse effects; Aminolevulinic Acid - therapeutic use; Barrett Esophagus - drug therapy; Barrett Esophagus - surgery; Biological and medical sciences; Digestive system; Esophagoscopy - methods; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Laser Coagulation - adverse effects; Laser Coagulation - methods; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Photochemotherapy - adverse effects; Photochemotherapy - methods; Photosensitizing Agents - adverse effects; Photosensitizing Agents - therapeutic use; Treatment Outcome; Biological fluid; Randomization; Treatment; Esophageal disease; Digestive diseases; Barrett esophagus; Ablation; Phototherapy; Blood plasma
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2004.02277.x

Summary Background : Barrett's oesophagus is the major risk factor for oesophageal adenocarcinoma. 5‐Aminlevulinic acid‐induced photodynamic therapy and argon plasma coagulation have been shown to be effective for ablating Barrett's oesophagus, but a comparative trial of these two modalities has not been reported. Aims : To compare photodynamic therapy and argon plasma coagulation for the ablation of Barrett's oesophagus. Methods : A total of 68 patients (54 male, 14 female; median age 61) with Barrett's oesophagus were randomized to photodynamic therapy (n = 34) or argon plasma coagulation (n = 34). Photodynamic therapy was performed using 5‐aminlevulinic acid (30 mg/kg) and red light. Argon plasma coagulation was administered at a power setting of 65 W. Multiple treatment sessions were performed, with follow‐up to 24 months. Results : All patients showed a macroscopic reduction in the area of Barrett's oesophagus. This was greatest in the argon plasma coagulation group with 33 of 34 (97%) ablated, compared with 17 of 34 (50%) in the photodynamic therapy group; in the remainder, there was a reduction in the length of Barrett's oesophagus (median 50%, range: 5–90). Buried glands were found in 24% of photodynamic therapy patients, and in 21% of argon plasma coagulation patients. The median follow‐up is 12 months (range: 6–24). Conclusions : Photodynamic therapy and argon plasma coagulation are both effective for ablating Barrett's oesophagus. Argon plasma coagulation appears more effective than photodynamic therapy, but the impact of both on carcinoma development requires larger studies with long‐term follow‐up.