Photodynamic therapy in Barrett's esophagus: reduction of specialized mucosa, ablation of dysplasia, and treatment of superficial esophageal cancer

Semin Surg Oncol. Sep-Oct 1995;11(5):372-6. doi: 10.1002/ssu.2980110508.

Abstract

Twelve patients with Barrett's esophagus and dysplasia were treated with photodynamic therapy. Five patients also had early, superficial esophageal cancers and five had esophageal polyps. Light was delivered via a standard diffuser or a centering esophageal balloon. Patients were maintained on omeprazole and followed for 6-54 months. In patients with Barrett's esophagus, photodynamic therapy ablated dysplastic mucosa and malignant mucosa in patients with superficial cancer. Healing and partial replacement of Barrett's mucosa with normal squamous epithelium occurred in all patients and complete replacement with squamous epithelium was found in three patients. Side effects included photosensitivity and mild-moderate chest pain and dysphagia for 5-7 days. In four patients with extensive circumferential mucosal ablation in the mid or proximal esophagus, healing was associated with esophageal strictures which were treated successfully by esophageal dilation. Strictures were not found in the distal esophagus. Photodynamic therapy combined with long-term acid inhibition provides effective endoscopic therapy of Barrett's mucosal dysplasia and superficial (Tis-T1) esophageal cancer. The windowed centering balloon improves delivery of photodynamic therapy to diffusely abnormal esophageal mucosa.

MeSH terms

  • Adenocarcinoma / drug therapy*
  • Anti-Ulcer Agents / therapeutic use
  • Barrett Esophagus / drug therapy*
  • Barrett Esophagus / pathology
  • Catheterization / instrumentation
  • Chest Pain / etiology
  • Deglutition Disorders / etiology
  • Epithelium / drug effects
  • Epithelium / pathology
  • Esophageal Neoplasms / drug therapy*
  • Esophageal Stenosis / etiology
  • Esophageal Stenosis / therapy
  • Esophagoscopy
  • Esophagus / drug effects*
  • Esophagus / pathology
  • Follow-Up Studies
  • Hematoporphyrin Derivative / administration & dosage
  • Hematoporphyrin Derivative / therapeutic use
  • Humans
  • Omeprazole / therapeutic use
  • Photochemotherapy* / adverse effects
  • Photochemotherapy* / instrumentation
  • Photochemotherapy* / methods
  • Photosensitivity Disorders / etiology
  • Polyps / drug therapy
  • Wound Healing

Substances

  • Anti-Ulcer Agents
  • Hematoporphyrin Derivative
  • Omeprazole