Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett's esophagus

Gastrointest Endosc. 2005 Apr;61(4):506-14. doi: 10.1016/s0016-5107(05)00063-5.


Background: The aim of this study was to prospectively evaluate endoscopic resection (ER) combined with photodynamic therapy (PDT) for the treatment of selected patients with early neoplasia in Barrett's esophagus.

Methods: Patients with Barrett's esophagus and neoplastic lesions <2 cm in diameter and no sign of submucosal infiltration, positive lymph nodes, or distant metastasis underwent diagnostic ER (cap technique). Patients with a T1sm tumor in the resection specimen were referred for surgery; those with a T1m or a less invasive tumor underwent additional endoscopic therapy (ER, PDT, and/or argon plasma coagulation [APC]), or they were followed. PDT was performed with 5-aminolevulinic acid and a light dose of 100 J/cm 2 at lambda = 632 nm.

Results: Thirty-three patients underwent diagnostic ER. Endoscopic treatment was not performed in 5 patients, who underwent surgery (4 T1sm; 1, patient preference). Five patients were immediately entered into a follow-up protocol, and 23 received additional endoscopic treatment (13 additional ER, 19 PDT, 3 APC). Endoscopic treatment was successful in 26/28 patients; no severe complication was observed. During follow-up (median 19 months, range 13-24 months), 5/26 patients had a recurrence of high-grade dysplasia: all were successfully re-treated with ER. At the end of follow-up, 26/33 originally enrolled patients (79%) and 26/28 endoscopically treated patients (93%) were in local remission.

Conclusions: Endoscopic therapy is safe and effective for selected patients with early stage neoplasia in Barrett's esophagus.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Argon
  • Barrett Esophagus / complications
  • Barrett Esophagus / pathology
  • Barrett Esophagus / therapy*
  • Esophageal Neoplasms / etiology
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / therapy*
  • Esophagoscopy*
  • Female
  • Humans
  • Laser Coagulation*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Photochemotherapy*
  • Prospective Studies
  • Treatment Outcome


  • Argon