Photodynamic therapy for dysplastic Barrett's oesophagus: a prospective, double blind, randomised, placebo controlled trial

Abstract

Background and aims-Photodynamic therapy (PDT) is a treatment in which cell damage is achieved by the action of light on a photosensitising agent. We have assessed the potential use of PDT in the ablation of Barrett's oesophagus. Methods-Thirty six patients with dysplastic Barrett's oesophagus receiving acid suppression medication with omeprazole were randomised to receive oral 5-aminolaevulinic acid (ALA) 30 mg/kg or placebo, followed four hours later by laser endoscopy. Follow up endoscopy was performed at one, six, 12, and 24 months. Results-Of 18 patients in the ALA group, a response was seen in 16 (median decrease in area in the treated region 30%; range 0-60%). In the placebo group, a decrease in area of 10% was observed in two patients with no change in 16 (median 0%; range 0-10%; treatment v placebo, p<0.001). No dysplasia was seen in the columnar epithelium within the treatment area of any patient in the PDT group. However, in the placebo group, persistent low grade dysplasia was found in 12 patients (p<0.001). There were no short or long term major side eVects. The eVects of treatment were maintained for up to 24 months. Conclusions-This is the first randomised controlled trial of PDT for Barrett's oesophagus. It demonstrates that ALA induced PDT can provide safe and eVective ablation of low grade dysplastic epithelium. (Gut 2000;47:612-617)

Genomic analysis of Barrett's esophagus after ablative therapy: Persistence of genetic alterations at tumor suppressor loci

“…[5][6][7] Most commonly used ablative therapies are argon plasma coagulation and photodynamic therapy. [8][9][10][11][12][13][14][15][16][17] However, success rates of these therapies vary and complete ablation is not achieved in all patients. Further, residual BE may be present after ablation in at least one-third of the patients and may be hidden underneath the restored squamous epithelial lining.…”

The Effects of Photodynamic Therapy in Upper-Gastrointestinal Malignant Diseases

“…The reported rate of successful ablation of combined low grade dysplasia or Barrett's esophagus itself ranges from 82% to 100%, and successful ablation rate in high grade dysplasia or cancer was 77% to 91% (Table 3). 9,[12][13][14][15][16] However, these studies confirmed the feasibility, safety of the PDT, and obtained mixed success as well in terms tumor response. Some report complete histologic response in "advanced" tumors, whereas others report only partial response even in "early" tumors.…”

Photodynamic Therapy in Oncology

“…Several cases of unexplained sudden death after ALA PDT were also reported at the recent International Photodynamic Association congress (Munich, Germany, June 2005). Less penetrating green light (514 nm) has also been successfully used in combination with ALA and porfimer sodium with correspondingly less effective rates of ablation [94,95].…”