Background and Study Aims: The methods of endoscopic ablation of metaplastic and dysplastic areas in Barrett’s esophagus so far described, are not satisfactory with respect to efficacy and safety. Therefore we investigated whether photodynamic therapy (PDT) with topical δ-aminolevulinic acid (δ-ALA) leads to ablation of specialized columnar epithelium and eradication of low-grade dysplasia while not producing phototoxicity and systemic side effects.
Patients and Methods: 14 patients with histologically proven Barrett’s esophagus, seven of whom had evidence of low-grade dysplasia, underwent endoscopic treatment with topical δ-ALA. Photoactivation (wavelength, 632 nm) was performed at 1.5 - 2 hours after drug administration using an argon dye laser. Patients received omeprazole 80 mg daily for 2 months; thereafter; maintenance therapy depended on reflux symptoms. Patients were endoscopically re-evaluated after 7 days, and subsequently at 3, 6, 12 and up to 48 months (mean follow up 33 months). Re-treatment with high-dose topical δ-ALA was offered to the 11 patients with remaining metaplasia and was carried out in five of them.
Results: Low-grade dysplasia was eradicated in all patients. One patient with no dysplasia before PDT developed a high-grade dysplasia after PDT. Complete ablation of Barrett’s metaplasia was observed in 21 % of the patients after the first treatment session and in 20 % after the second treatment session. The mean reduction in the length of Barrett’s metaplasia was 1.54 ± 1.29 cm after the first PDT session and 1.02 ± 0.80 cm after the second PDT session. Post-endoscopic pain and photosensitivity reactions were less frequent with low-dose δ-ALA PDT than with high-dose PDT (pain 15 %, 100 %, respectively; P = 0.001 by Fisher’s exact test; phototoxicity, 0 %, 50 %, respectively; P = 0.021 by Fisher’s exact test).
Conclusion: Low-dose topical administration of δ-ALA provides ablation of low-grade dysplasia in the range obtained with oral δ-ALA. In addition, it is safe and well tolerated. Since, however, topical administration of δ-ALA is not able to consistently eradicate Barrett’s esophagus, alternative methods will have to be developed.
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M.-A. Ortner, M.D.
Department of Gastroenterology, Hepatology, Endocrinology, Metabolism, and Nutrition · Medical Faculty Charité · Humboldt University
Schumannstrasse 20 - 21 · 10117 Berlin · Germany ·
Fax: + 49-30-28028978
Email: Marianne.Ortner@charite.de
