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Clinical experience of patients undergoing photodynamic therapy for Barrett's dysplasia or cancer.
Aliment Pharmacol Ther. 2004 Nov 15; 20(10):1125-31.AP

Abstract

INTRODUCTION

Barrett's oesophagus is the most important risk factor in the increase in incidence of oesophageal adenocarcinoma. Photodynamic therapy using porfimer sodium is the only approved endoscopic treatment for use in patients with Barrett's high-grade dysplasia.

AIM

To determine clinical characteristics, endoscopic findings and treatment complications in Barrett's high-grade dysplasia patients undergoing photodynamic therapy.

METHODS

We reviewed our experience using porfimer sodium photodynamic therapy to treat patients with Barrett's oesophagus and high-grade dysplasia or mucosal carcinoma. Data collected included patients characteristics, presentation symptoms, endoscopic findings, subsequent use of surveillance endoscopy and outcome after photodynamic therapy.

RESULTS

Since 1997, 102 patients with Barrett's high-grade dysplasia (69 patients) or mucosal adenocarcinoma (33 patients) have been treated with photodynamic therapy using porfimer sodium as an alternative to oesophagectomy (median series follow-up time = 1.6 years). Almost half (46%) of patients had high-grade dysplasia or carcinoma detected on their first endoscopy and the remainder (54%) were found during surveillance of known Barrett's oesophagus. Symptoms typically associated with oesophageal disease were only found in 29 of 47 (62%) patients in whom dysplasia/carcinoma was detected on the initial endoscopy - chest pain in 13 patients, dysphagia in nine patients and chronic gastro-oesophageal disease in seven patients. Comparison of endoscopic characteristics found the median Barrett's glandular segment length was significantly shorter in adenocarcinoma patients (median 3 cm; range: 1-12) vs. Barrett's high-grade dysplasia patients (median 5 cm; range: 1-16, P < 0.001). Overall treatment results found complete ablation of glandular epithelium with one course of photodynamic therapy in most patients (56%). Stricture requiring dilation occurred in 20 patients (20%) was the most common serious adverse event. Photodynamic therapy failed to ablate dysplasia or carcinoma in four patients and subsequent oesophagectomy was curative in three of these patients.

CONCLUSIONS

Approximately 40% of newly diagnosed patients with Barrett's associated dysplasia or carcinoma had no oesophageal symptoms and had carcinoma associated with short segment (3 cm or less). Photodynamic therapy is a highly effective, safe and minimally invasive first-line treatment for patients with Barrett's dysplasia and mucosal adenocarcinoma.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA. pdt@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15569115

Citation

Wolfsen, H C., et al. "Clinical Experience of Patients Undergoing Photodynamic Therapy for Barrett's Dysplasia or Cancer." Alimentary Pharmacology & Therapeutics, vol. 20, no. 10, 2004, pp. 1125-31.
Wolfsen HC, Hemminger LL, Wallace MB, et al. Clinical experience of patients undergoing photodynamic therapy for Barrett's dysplasia or cancer. Aliment Pharmacol Ther. 2004;20(10):1125-31.
Wolfsen, H. C., Hemminger, L. L., Wallace, M. B., & Devault, K. R. (2004). Clinical experience of patients undergoing photodynamic therapy for Barrett's dysplasia or cancer. Alimentary Pharmacology & Therapeutics, 20(10), 1125-31.
Wolfsen HC, et al. Clinical Experience of Patients Undergoing Photodynamic Therapy for Barrett's Dysplasia or Cancer. Aliment Pharmacol Ther. 2004 Nov 15;20(10):1125-31. PubMed PMID: 15569115.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical experience of patients undergoing photodynamic therapy for Barrett's dysplasia or cancer. AU - Wolfsen,H C, AU - Hemminger,L L, AU - Wallace,M B, AU - Devault,K R, PY - 2004/12/1/pubmed PY - 2005/3/15/medline PY - 2004/12/1/entrez SP - 1125 EP - 31 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 20 IS - 10 N2 - INTRODUCTION: Barrett's oesophagus is the most important risk factor in the increase in incidence of oesophageal adenocarcinoma. Photodynamic therapy using porfimer sodium is the only approved endoscopic treatment for use in patients with Barrett's high-grade dysplasia. AIM: To determine clinical characteristics, endoscopic findings and treatment complications in Barrett's high-grade dysplasia patients undergoing photodynamic therapy. METHODS: We reviewed our experience using porfimer sodium photodynamic therapy to treat patients with Barrett's oesophagus and high-grade dysplasia or mucosal carcinoma. Data collected included patients characteristics, presentation symptoms, endoscopic findings, subsequent use of surveillance endoscopy and outcome after photodynamic therapy. RESULTS: Since 1997, 102 patients with Barrett's high-grade dysplasia (69 patients) or mucosal adenocarcinoma (33 patients) have been treated with photodynamic therapy using porfimer sodium as an alternative to oesophagectomy (median series follow-up time = 1.6 years). Almost half (46%) of patients had high-grade dysplasia or carcinoma detected on their first endoscopy and the remainder (54%) were found during surveillance of known Barrett's oesophagus. Symptoms typically associated with oesophageal disease were only found in 29 of 47 (62%) patients in whom dysplasia/carcinoma was detected on the initial endoscopy - chest pain in 13 patients, dysphagia in nine patients and chronic gastro-oesophageal disease in seven patients. Comparison of endoscopic characteristics found the median Barrett's glandular segment length was significantly shorter in adenocarcinoma patients (median 3 cm; range: 1-12) vs. Barrett's high-grade dysplasia patients (median 5 cm; range: 1-16, P < 0.001). Overall treatment results found complete ablation of glandular epithelium with one course of photodynamic therapy in most patients (56%). Stricture requiring dilation occurred in 20 patients (20%) was the most common serious adverse event. Photodynamic therapy failed to ablate dysplasia or carcinoma in four patients and subsequent oesophagectomy was curative in three of these patients. CONCLUSIONS: Approximately 40% of newly diagnosed patients with Barrett's associated dysplasia or carcinoma had no oesophageal symptoms and had carcinoma associated with short segment (3 cm or less). Photodynamic therapy is a highly effective, safe and minimally invasive first-line treatment for patients with Barrett's dysplasia and mucosal adenocarcinoma. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/15569115/Clinical_experience_of_patients_undergoing_photodynamic_therapy_for_Barrett's_dysplasia_or_cancer_ L2 - https://doi.org/10.1111/j.1365-2036.2004.02209.x DB - PRIME DP - Unbound Medicine ER -