Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett's esophagus

Buttar, Navtej; Wang, Kenneth Ke Ning; Lutzke, Lori S.; Krishnadath, Krishnawatie K.; Anderson, Marlys

doi:10.1067/gien.2001.0003

Cited by 107 publications

(90 citation statements)

References 22 publications

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“…9,10 Different endoscopic ablation techniques with variable success rates have been reported for the treatment of HGD. [11][12][13][14][15][16] Photodynamic therapy (PDT) uses the combination of a photosensitizer and light. Exposure to light of a specific wavelength leads to activation of the photosensitizer followed by creation of singlet oxygen, which causes tissue injury and is thought to be mediated by apoptosis, vascular injury, and the induction of immune and inflammatory responses.…”

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confidence: 99%

Utility of Biomarkers in Prediction of Response to Ablative Therapy in Barrett's Esophagus

et al. 2008

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Background & Aims-Photodynamic therapy (PDT) has been shown to be effective in the treatment of high-grade dysplasia (HGD)/mucosal carcinoma in Barrett's esophagus (BE). Substantial proportions of patients do not respond to PDT or progress to carcinoma despite PDT. The role of biomarkers in predicting response to PDT is unknown. We aimed to determine if biomarkers known to be associated with neoplasia in BE can predict loss of dysplasia in patients treated with ablative therapy for HGD/intramucosal cancer.

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Utility of Biomarkers in Prediction of Response to Ablative Therapy in Barrett's Esophagus

et al. 2008

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“…In this capacity and either alone or in conjunction with other ablative techniques results appear quite favorable. 11,12,[39][40][41][42] Reports of extended resection of flat mucosa have been published; however, it is likely that such extensive therapy will require considerable expertise and not be routinely available in clinical practice.…”

Section: Therapy For Barrett's Esophagusmentioning

confidence: 99%

Surveillance in Barrett's Esophagus: A Failed Premise

Inadomi

2009

Keio J. Med.

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Background: It is recommended that patients in whom Barrett's esophagus is diagnosed undergo surveillance endoscopy. However, multiple issues regarding the efficacy and feasibility of surveillance remain. Methods: Quantitative techniques were used to examine surveillance in patients with Barrett's esophagus. A retrospective case-control study was performed to determine whether surveillance endoscopy prolonged survival in a cohort of U.S. veterans diagnosed with esophageal adenocarcinoma. Cost-effectiveness analysis was employed to compare competing strategies of management for patients with Barrett's esophagus to determine whether surveillance strategies using alternative biomarkers could out-perform dysplasia based surveillance, and whether new techniques for eradicating Barrett's metaplasia would constitute cost-effective strategies. Results: Surveillance did not improve long-term survival among veterans diagnosed with esophageal adenocarcinoma. Lead-time bias has confounded previous reports claiming the efficacy of endoscopic surveillance. Cost-effectiveness analysis revealed that while screening 50-year old Caucasian males with heartburn may be cost-effective, surveillance even at 5 year intervals among patients with Barrett's esophagus without dysplasia exceeded the threshold of cost-effective care. If a biomarker were developed whose sensitivity and specificity to predict cancer development exceeded 80%, this could represent a more viable strategy than dysplasia-based surveillance and overcome the inherent inter-and intra-observer variations in dysplasia diagnosis that currently limit the effectiveness of surveillance programs. Finally, techniques that reduce cancer incidence such as endoscopic mucosal resection or ablation will likely be more cost-effective than current surveillance strategies that rely on early detection of cancer. Conclusions : Current recommendations for the management of patients with Barrett's esophagus are flawed. Future guidelines should include alternative markers of cancer risk and focus on strategies that reduce cancer incidence instead of cancer detection. (Keio J Med 58 (1) : 12

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“…When HGD is diagnosed in short segment BE (BE shorter than 30 mm in length), EMR would be considered to remove all the metaplastic epithelium. A study reported that visible areas of HGD in long segment BE (BE longer than 30 mm in length) may be removed by EMR, followed by photodynamic therapy to destroy invisible foci [19] . Although strictures occurred in 30% of patients, 17 superficial esophageal cancers were removed by combining EMR and photodynamic therapy.…”

Section: Scc Of the Esophagusmentioning

confidence: 99%

Endoscopic resection of superficial gastrointestinal tumors

Giovannini

Lopes²

2008

WJG

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Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract.

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Combined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett's esophagus

Cited by 107 publications

References 22 publications

Utility of Biomarkers in Prediction of Response to Ablative Therapy in Barrett's Esophagus

Utility of Biomarkers in Prediction of Response to Ablative Therapy in Barrett's Esophagus

Surveillance in Barrett's Esophagus: A Failed Premise

Endoscopic resection of superficial gastrointestinal tumors

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