Photodynamic therapy for Barrett's esophagus: follow-up in 100 patients☆,☆☆,★
Section snippets
PATIENTS AND METHODS
One hundred consecutive patients, 78 men and 22 women, referred for PDT of Barrett's esophagus with dysplasia or early carcinoma were treated and followed for 4 to 84 months, with a mean of 19 months. Age ranged from 33 to 83 years with a mean of 66 years. All patients had undergone repeated endoscopic examinations and biopsies that demonstrated Barrett's esophagus with intestinal metaplasia and dysplasia based on published criteria.4 Thirteen patients had superficial cancers, 0.2 to 1.2 cm in
RESULTS
Although the diffuser (non-balloon) system produced extensive injury to exposed mucosa along with destruction of dysplastic epithelium and small cancers, there were occasional small areas of mucosa that were not damaged, presumably due in part to the effects of esophageal motility, cardiac and respiratory movement on the position of the probe, and shadowing due to the collapse of esophageal folds around the diffuser probe in the nondistended esophagus. The centering balloon system provided more
DISCUSSION
A minimally invasive treatment for reduction of Barrett's mucosa and the ablation of dysplasia and superficial cancers is desirable. Certainly, an alternative to esophagectomy is needed because of the high morbidity and mortality associated with this operation.23, 24, 25, 26, 27, 28, 29
Medical30, 31, 32, 33, 34, 35, 36 and surgical therapy37, 38, 39 have been used in an attempt to reduce the extent of Barrett's mucosa, but the results have been controversial40 and no therapy has consistently
Acknowledgements
Photofrin and laser fibers were provided by QLT PhotoTherapeutics, Vancouver, BC, Canada.
Two authors (B.F.O., M.P.) have a pending patent application for the centering balloon.
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Supported in part by grants from the Thompson Charitable Trust and Quadralogics, Inc., Vancouver, BC, Canada.
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Reprint requests: Bergein F. Overholt, MD, P.O. Box 59002, Knoxville, TN 37950-9002.
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