Eradication of Dysplastic Barrett’s Oesophagus Using Photodynamic Therapy: Long-Term Follow-Up

Background and Study Aims: Barrett’s oesophagus is a major risk factor for oesophageal adenocarcinoma, a condition which is rapidly increasing in incidence. Photodynamic therapy (PDT) is a developing treatment in which tissue damage is caused by the action of light on a previously administered photosensitizing agent. We present the results of long-term follow-up of its efficacy in patients with dysplastic Barrett’s oesophagus.
Patients and Methods: A total of 40 patients with low-grade dysplasia in Barrett’s oesophagus were treated with oral 5-aminolaevulinic acid (ALA) at a dose of 30 mg/kg, followed by laser endoscopy 4 hours later. Patients were treated between December 1995 and December 1998, and all were followed up regularly with endoscopy and biopsies in our surveillance programme.

Results: Among the patients, 35 (88 %) showed a macroscopic reduction in the area of the columnar epithelium, and in all 40 patients dysplasia was found to be eradicated at 1 month. The effect has been maintained for a median follow-up of 53 months (range 18 - 68 months), although one patient developed a late carcinoma in an untreated area of Barrett’s oesophagus 3 years after the intervention.
Conclusions: Safe and effective ablation of low-grade dysplastic Barrett’s oesophagus can be achieved with the use of ALA-induced PDT, and the effects are maintained in the long term.

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