Endoscopy 2005; 37(5): 418-424
DOI: 10.1055/s-2005-861198
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Poor Results of 5-Aminolevulinic Acid-Photodynamic Therapy for Residual High-Grade Dysplasia and Early Cancer in Barrett Esophagus after Endoscopic Resection

F.  Peters1 , M.  Kara1 , W.  Rosmolen1 , M.  Aalders2 , F.  ten Kate3 , K.  Krishnadath1 , J.  van Lanschot4 , P.  Fockens1 , J.  Bergman1
  • 1Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
  • 2Laser Center, Academic Medical Center, Amsterdam, Netherlands
  • 3Department of Pathology, Academic Medical Center, Amsterdam, Netherlands
  • 4Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
Further Information

Publication History

Submitted 30 September 2004

Accepted after Revision 10 December 2004

Publication Date:
20 April 2005 (online)

Background and Study Aims: The aim of the study was to evaluate the efficacy of photodynamic therapy (PDT) in the treatment of residual high-grade dysplasia or early cancer (HGD/EC) after endoscopic resection in Barrett esophagus.
Patients and Methods: Study patients were separated into group A, with proven residual HGD/EC, and group B with possible HGD/EC (positive lateral margins in the endoscopic resection specimen, without HGD/EC in the remaining Barrett esophagus). PDT treatment consisted of 5-aminolevulinic (5-ALA) photosensitization (40 mg/kg) followed by illumination of the Barrett esophagus with a total light dose of 100 J/cm2. Complete remission was defined as the absence of HGD/EC in biopsies taken in two consecutive follow-up endoscopies. The percentage regression of Barrett esophagus, as well as the recurrence rate of HGD/EC, was calculated.

Results: 20 patients underwent PDT (group A, 11; group B, 9). Mild complications were seen in 4/26 procedures. The overall success rate was 15/20 (75 %). There was a significant difference in success rate between group A (55 %) and group B (100 %); P = 0.03. All patients had residual Barrett esophagus after PDT; the median regression percentage was 50 % (IQR 25 - 70 %). Recurrence of HGD/EC occurred in four patients (two each in groups A and B) after a median follow up of 30 months.

Conclusions: In this selected group of patients, the addition of 5-ALA-PDT after endoscopic resection for HGD/EC had a disappointing success rate in patients who had residual HGD/EC after endoscopic resection. Most patients undergoing 5-ALA-PDT have residual Barrett mucosa after PDT and 5-ALA-PDT does not seem to prevent recurrences during follow-up.

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J. J. G. H. M. Bergman, M. D. Ph. D.

Department of Gastroenterology and Hepatology, Academic Medical Center

Meibergdreef 9 · 1105 AZ, Amsterdam · The Netherlands

Email: j.j.bergman@amc.uva.nl