Patients Undergoing Photodynamic Therapy for Barrett's Dysplasia
Patients Undergoing Photodynamic Therapy for Barrett's Dysplasia
Introduction: Barrett's oesophagus is the most important risk factor in the increase in incidence of oesophageal adenocarcinoma. Photodynamic therapy using porfimer sodium is the only approved endoscopic treatment for use in patients with Barrett's high-grade dysplasia.
Aim: To determine clinical characteristics, endoscopic findings and treatment complications in Barrett's high-grade dysplasia patients undergoing photodynamic therapy.
Methods: We reviewed our experience using porfimer sodium photodynamic therapy to treat patients with Barrett's oesophagus and high-grade dysplasia or mucosal carcinoma. Data collected included patients characteristics, presentation symptoms, endoscopic findings, subsequent use of surveillance endoscopy and outcome after photodynamic therapy.
Results: Since 1997, 102 patients with Barrett's high-grade dysplasia (69 patients) or mucosal adenocarcinoma (33 patients) have been treated with photodynamic therapy using porfimer sodium as an alternative to oesophagectomy (median series follow-up time = 1.6 years). Almost half (46%) of patients had high-grade dysplasia or carcinoma detected on their first endoscopy and the remainder (54%) were found during surveillance of known Barrett's oesophagus. Symptoms typically associated with oesophageal disease were only found in 29 of 47 (62%) patients in whom dysplasia/carcinoma was detected on the initial endoscopy - chest pain in 13 patients, dysphagia in nine patients and chronic gastro-oesophageal disease in seven patients. Comparison of endoscopic characteristics found the median Barrett's glandular segment length was significantly shorter in adenocarcinoma patients (median 3 cm; range: 1-12) vs. Barrett's high-grade dysplasia patients (median 5 cm; range: 1-16, P < 0.001). Overall treatment results found complete ablation of glandular epithelium with one course of photodynamic therapy in most patients (56%). Stricture requiring dilation occurred in 20 patients (20%) was the most common serious adverse event. Photodynamic therapy failed to ablate dysplasia or carcinoma in four patients and subsequent oesophagectomy was curative in three of these patients.
Conclusions: Approximately 40% of newly diagnosed patients with Barrett's associated dysplasia or carcinoma had no oesophageal symptoms and had carcinoma associated with short segment (3 cm or less). Photodynamic therapy is a highly effective, safe and minimally invasive first-line treatment for patients with Barrett's dysplasia and mucosal adenocarcinoma.
Barrett's oesophagus is thought to be the result of long-standing gastro-oesophageal reflux disease (GERD) and is known to be the most important risk factor for the development of oesophageal adenocarcinoma. Barrett's high-grade dysplasia (HGD) is the histological disease stage that immediately precedes the development of invasive neoplasm. Photodynamic therapy (PDT) is a 'drug and device' treatment that combines a photosensitizer drug and laser light energy to induce a photochemical reaction triggering mucosal ablation. In August 2003, regulatory approval was granted in the USA and Canada for the use of porfimer sodium PDT in Barrett's HGD patients based on a multicentre randomized-controlled trial documenting significantly fewer carcinomas in treated patients.
Traditionally, Barrett's metaplasia, dysplasia and cancer have been diagnosed in elderly white male patients with >3 cm of glandular epithelium and a long history of severe acid reflux symptoms. Recent studies have emphasized the risk of carcinoma in patients with short segment Barrett's disease as well as the large number of Barrett's patients who have little or no symptoms of acid reflux disease. We have experience with a large group of patients with Barrett's HGD and mucosal carcinoma, including a significant number of women, who we have treated with endoscopic ablation therapy using porfimer sodium PDT. The purpose of this study was to determine the clinical characteristics including presentation symptoms and previous use of endoscopic surveillance, endoscopic findings and treatment complications in these patients.
Introduction: Barrett's oesophagus is the most important risk factor in the increase in incidence of oesophageal adenocarcinoma. Photodynamic therapy using porfimer sodium is the only approved endoscopic treatment for use in patients with Barrett's high-grade dysplasia.
Aim: To determine clinical characteristics, endoscopic findings and treatment complications in Barrett's high-grade dysplasia patients undergoing photodynamic therapy.
Methods: We reviewed our experience using porfimer sodium photodynamic therapy to treat patients with Barrett's oesophagus and high-grade dysplasia or mucosal carcinoma. Data collected included patients characteristics, presentation symptoms, endoscopic findings, subsequent use of surveillance endoscopy and outcome after photodynamic therapy.
Results: Since 1997, 102 patients with Barrett's high-grade dysplasia (69 patients) or mucosal adenocarcinoma (33 patients) have been treated with photodynamic therapy using porfimer sodium as an alternative to oesophagectomy (median series follow-up time = 1.6 years). Almost half (46%) of patients had high-grade dysplasia or carcinoma detected on their first endoscopy and the remainder (54%) were found during surveillance of known Barrett's oesophagus. Symptoms typically associated with oesophageal disease were only found in 29 of 47 (62%) patients in whom dysplasia/carcinoma was detected on the initial endoscopy - chest pain in 13 patients, dysphagia in nine patients and chronic gastro-oesophageal disease in seven patients. Comparison of endoscopic characteristics found the median Barrett's glandular segment length was significantly shorter in adenocarcinoma patients (median 3 cm; range: 1-12) vs. Barrett's high-grade dysplasia patients (median 5 cm; range: 1-16, P < 0.001). Overall treatment results found complete ablation of glandular epithelium with one course of photodynamic therapy in most patients (56%). Stricture requiring dilation occurred in 20 patients (20%) was the most common serious adverse event. Photodynamic therapy failed to ablate dysplasia or carcinoma in four patients and subsequent oesophagectomy was curative in three of these patients.
Conclusions: Approximately 40% of newly diagnosed patients with Barrett's associated dysplasia or carcinoma had no oesophageal symptoms and had carcinoma associated with short segment (3 cm or less). Photodynamic therapy is a highly effective, safe and minimally invasive first-line treatment for patients with Barrett's dysplasia and mucosal adenocarcinoma.
Barrett's oesophagus is thought to be the result of long-standing gastro-oesophageal reflux disease (GERD) and is known to be the most important risk factor for the development of oesophageal adenocarcinoma. Barrett's high-grade dysplasia (HGD) is the histological disease stage that immediately precedes the development of invasive neoplasm. Photodynamic therapy (PDT) is a 'drug and device' treatment that combines a photosensitizer drug and laser light energy to induce a photochemical reaction triggering mucosal ablation. In August 2003, regulatory approval was granted in the USA and Canada for the use of porfimer sodium PDT in Barrett's HGD patients based on a multicentre randomized-controlled trial documenting significantly fewer carcinomas in treated patients.
Traditionally, Barrett's metaplasia, dysplasia and cancer have been diagnosed in elderly white male patients with >3 cm of glandular epithelium and a long history of severe acid reflux symptoms. Recent studies have emphasized the risk of carcinoma in patients with short segment Barrett's disease as well as the large number of Barrett's patients who have little or no symptoms of acid reflux disease. We have experience with a large group of patients with Barrett's HGD and mucosal carcinoma, including a significant number of women, who we have treated with endoscopic ablation therapy using porfimer sodium PDT. The purpose of this study was to determine the clinical characteristics including presentation symptoms and previous use of endoscopic surveillance, endoscopic findings and treatment complications in these patients.
Source...