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

R. Ackroyd; C. J. Kelty; N. J. Brown; T. J. Stephenson; C. J. Stoddard; M. W. R. Reed

doi:10.1055/s-2003-39676

Endoscopy, Table of Contents

Endoscopy 2003; 35(6): 496-501
DOI: 10.1055/s-2003-39676

Original Article

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

R. Ackroyd ¹ , C. J. Kelty ² , N. J. Brown ² , T. J. Stephenson ³ , C. J. Stoddard ¹ , M. W. R. Reed ²

¹ Department of Surgery, Sheffield Teaching Hospitals, Sheffield, UK
² Academic Unit of Surgical Oncology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
³ Department of Histopathology, Sheffield Teaching Hospitals, Sheffield, UK

Abstract

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.

Full Text

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R. Ackroyd, M.D.

Department of Surgery, K Floor

Royal Hallamshire Hospital · Glossop Road · Sheffield, S10 2JF · UK

Fax: + 44-114-2713791

Email: r.ackroyd@sheffield.ac.uk