Aminolevulinic acid-induced photodynamic therapy: safe and effective ablation of dysplasia in Barrett's esophagus

• Published in: Diseases of the esophagus Vol. 13; no. 1; pp. 18 - 22
• Main Authors: Ackroyd, R., Brown, N. J., Davis, M. F., Stephenson, T. J., Stoddard, C. J., Reed, M. W. R.
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Science Pty 01.03.2000
• Subjects: Aminolevulinic Acid - therapeutic use; Barrett Esophagus - drug therapy; Barrett Esophagus - pathology; Follow-Up Studies; Humans; Photochemotherapy; Photosensitizing Agents - therapeutic use
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1046/j.1442-2050.2000.00067.x

Photodynamic therapy (PDT) is a treatment in which cell damage is achieved by the action of light on a photosensitizer. The aim of this study was to assess the value of PDT in the treatment of Barrett’s esophagus with low‐grade dysplasia (LGD). Forty patients with dysplastic Barrett’s esophagus were given aminolevulinic acid (ALA) 30 mg /kg orally followed 4 h later by laser endoscopy. Follow‐up endoscopy and biopsies were performed at 1, 6 and 12 months. A macroscopic response was seen in 33 out of 40 patients, with a median decrease in columnar epithelial area of 30% (range 0–90%). Post‐treatment biopsies showed no dysplasia in 39 out of 40 patients, with LGD remaining in one case. This was maintained at 6 and 12 months. There were no significant side‐effects. This study demonstrates that ALA‐induced PDT provides safe and effective ablation therapy for Barrett’s esophagus and is particularly useful against dysplasia.