TITLE

HIGH GRADE DYSPLASIA IN BARRETT'S OESOPHAGUS: SUCCESSFUL ABLATION BY PHOTODYNAMIC THERAPY WITH ALA REQUIRES INTENSIVE THERAPY

AUTHOR(S)
Jamieson, N.F.; Thorpe, S.; Mosse, A.; Bown, S.G.; Lovat, L.B.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA20
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Oesophagectomy is considered first line therapy for high grade dysplasia (HGD) in Barrett's oesophagus but has considerable morbidity and mortality. Photodynamic therapy (PDT) using 5-aminolaevulinic acid (ALA) offers a minimally-invasive method for mucosal ablation of HGD. No published studies have attempted to optimise treatment conditions. Our aim was to confirm safety and determine the effect of light dose and treatment regime on outcome. Methods: With ethical approval, 22 patients with HGD (Vienna category 4) were treated from 1998. HGD was confirmed and carcinoma excluded by multiple biopsies, CT and EUS. Oesophagectomy was inappropriate because of co-morbidity or patient refusal. Patients received 60 mg/kg ALA orally (DUSA Pharmaceuticals Inc.) At endoscopy 4-6 h later, laser light (wavelength 633 nm) was delivered by diffuser fibre through an oesophageal balloon or silicone bolster at a dose of 500, 750 or 1000J/cm diffuser fibre. Follow up was by endoscopy and multiple biopsies after 1,3,6,9 and 12 months. PDT was repeated up to three times if HGD persisted. Results: Overall, 12/22 (55%) patients are clear of HGD, after a median follow up of 18 months. However, 9/12 (75%) patients treated with 1000 J are clear v 3/10 with lower light-doses (500-750 J) (p < 0.02). Two 1000 J treatments scheduled 4 weeks apart appears optimal: 8/9 (89%) clear of HGD at a median follow-up 7 months. HGD eradication was more likely when associated with a shorter Barrett's segment: median length 4 cm in successful treatments, 6 cm in failures (p < 0.02). There have been no deaths or oesophageal strictures. In a total follow-up of 40 patient-years, 4 HGD progressed to carcinoma but are clear of carcinoma after surgery (2), chemo-DXT (1) or PDT with a more potent agent (1). Conclusions: Photodynamic therapy using ALA is a safe initial approach to HGD in Barrett's oesophagus. Intensive therapy with two 1000 J/cm treatments 4 weeks apart appears the most effective...
ACCESSION #
9747391

 

Related Articles

  • Guidelines for the management of Barrett esophagus with high-grade dysplasia? Henteleff, Harry J.; Ellsmere, James C.; Rizk, Nabil // Canadian Journal of Surgery;Oct2011, Vol. 54 Issue 5, p352 

    Objective: To address the role of esophageal resection and other approaches that are becoming increasingly adopted for the management of Barrett esophagus with high-grade dysplasia (HGD). Data sources: MEDLINE, Cochrane Library and the Trip databases were searched for the terms "Barrett's or...

  • Endoscopic Management of Barrett's Esophagus: Advances in Endoscopic Techniques. Azarm, Ali; Lukolic, Ismet; Shukla, Meenal; Concha-Parra, Ronald; Gress, Frank // Digestive Diseases & Sciences;Dec2012, Vol. 57 Issue 12, p3055 

    Barrett's esophagus (BE) is a well-known premalignant condition that can be associated with the development of dysplasia and adenocarcinoma. In the past, esophagectomy was the standard treatment for patients with BE with high grade dysplasia (HGD) and early cancer (EC). However, esophagectomy is...

  • Can extent of high grade dysplasia in Barrett's oesophagus predict the presence of adenocarcinoma at oesophagectomy? Dar, M.S.; Goldblum, J.R.; Rice, T.W.; Falk, G.W. // Gut;Apr2003, Vol. 52 Issue 4, p486 

    Background: Optimal management of Barrett's oesophagus complicated by high grade dysplasia is controversial. Recently, the extent of high grade dysplasia was described as a predictor of subsequent development of cancer in patients undergoing continued surveillance. However, there is no universal...

  • MANAGEMENT OF HIGH GRADE DYSPLASIA (HGD) IN BARRETT'S OESOPHAGUS: A RETROSPECTIVE 10 YEAR RVIEW. Thomas, T.; Richards, C.J.; de Caestecker, J.; Robinson, R.J. // Gut;Apr2003 Supplement 1, Vol. 52, pA32 

    Background: Management of HGD in Barrett's remains controversial. Aim: To review management and outcome of HGD from three hospitals in one district. Methods: Case record study. Patients with dysplasia identified from pathology database. All HGD verified by at least two upper Gl pathologists and...

  • PHOTODYNAMIC THERAPY USING MTHPC FOR EARLY BARRETT'S-ASSOCIATED OESOPHAGEAL CANCERS. Jamieson, N.F.; Thorpe, S.; Mosse, A.; Brown, S.G.; Lovat, L.B. // Gut;Apr2003 Supplement 1, Vol. 52, pA46 

    Background: Oesophageal adenocarcinoma is rising in incidence and is strongly associated with Barrett's oesophagus. Oesophagectomy is the standard treatment for early carcinoma but has considerable morbidity and mortality. Photodynamic therapy (PDT) is a non-thermal minimally invasive technique...

  • The role of photodynamic therapy in the management of oral dysplasia. Hopper, Colin; Jerjes, Waseem; Hamdoon, Zaid; Upile, Tahwinder // Head & Neck Oncology;2010 Supplement 1, Vol. 2 Issue Suppl 1, p1 

    An abstract of the research paper "The Role of Photodynamic Therapy in the Management of Oral Dysplasia," by Colin Hopper and colleagues, presented at the second Scientific Meeting of the Head and Neck Optical Diagnostics Society in San Francisco, California, is presented.

  • Endoscopic Resection for Barrett's High-Grade Dysplasia and Early Esophageal Adenocarcinoma: An Essential Staging Procedure With Long-Term Therapeutic Benefit. Moss, Alan; Bourke, Michael J.; Hourigan, Luke F.; Gupta, Saurabh; Williams, Stephen J.; Tran, Kayla; Swan, Michael P.; Hopper, Andrew D.; Kwan, Vu; Bailey, Adam A. // American Journal of Gastroenterology;Jun2010, Vol. 105 Issue 6, p1276 

    OBJECTIVES:Patients with Barrett's high-grade dysplasia (HGD) or early esophageal adenocarcinoma (EAC) that is shown on biopsy alone continue to undergo esophagectomy without more definitive histological staging. Endoscopic resection (ER) may provide more accurate histological grading and local...

  • Adenocarcinoma in Childhood Barrett's Esophagus: Case Documentation and the Need for Surveillance in Children. Hassall, Eric; Dimmick, James E.; Magee, J. Fergall // American Journal of Gastroenterology;Feb1993, Vol. 88 Issue 2, p282 

    A 17-yr-old boy underwent esophagectomy for multifocal high-grade dysplasia and adenocarcinoma complicating Barrett's esophagus (BE). He is believed to be the first child or young adult to have prolonged healthy survival following resection of esophageal adenocarcinoma. Dysplasia in a short...

  • Esophagectomy for High Grade Dysplasia is Safe, Curative, and Results in Good Alimentary Outcome. Williams, Valerie A.; Watson, Thomas J.; Herbella, Fernando A.; Gellersen, Oliver; Raymond, Daniel; Jones, Carolyn; Peters, Jeffrey H. // Journal of Gastrointestinal Surgery;Dec2007, Vol. 11 Issue 12, p1589 

    Background The increasing adoption of endoscopic therapies and expectant surveillance for patients with high grade dysplasia (HGD) in Barrett's esophagus has created considerable controversy regarding the ideal treatment choice. Confusion may be due, in part, to a limited understanding of the...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics