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. 2000 Nov;47(5):612–617. doi: 10.1136/gut.47.5.612

Photodynamic therapy for dysplastic Barrett's oesophagus: a prospective, double blind, randomised, placebo controlled trial

R Ackroyd 1, N Brown 1, M Davis 1, T Stephenson 1, S Marcus 1, C Stoddard 1, A Johnson 1, M Reed 1
PMCID: PMC1728096  PMID: 11034574

Abstract

BACKGROUND AND AIMS—Photodynamic therapy (PDT) is a treatment in which cell damage is achieved by the action of light on a photosensitising agent. We have assessed the potential use of PDT in the ablation of Barrett's oesophagus.
METHODS—Thirty six patients with dysplastic Barrett's oesophagus receiving acid suppression medication with omeprazole were randomised to receive oral 5-aminolaevulinic acid (ALA) 30 mg/kg or placebo, followed four hours later by laser endoscopy. Follow up endoscopy was performed at one, six, 12, and 24 months.
RESULTS—Of 18 patients in the ALA group, a response was seen in 16 (median decrease in area in the treated region 30%; range 0-60%). In the placebo group, a decrease in area of 10% was observed in two patients with no change in 16 (median 0%; range 0-10%; treatment v placebo, p<0.001). No dysplasia was seen in the columnar epithelium within the treatment area of any patient in the PDT group. However, in the placebo group, persistent low grade dysplasia was found in 12 patients (p<0.001). There were no short or long term major side effects. The effects of treatment were maintained for up to 24 months.
CONCLUSIONS—This is the first randomised controlled trial of PDT for Barrett's oesophagus. It demonstrates that ALA induced PDT can provide safe and effective ablation of low grade dysplastic epithelium.


Keywords: Barrett's oesophagus; photodynamic therapy; aminolaevulinic acid; protoporphyrin IX

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Selected References

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  1. Ackroyd R., Brown N. J., Stephenson T. J., Stoddard C. J., Reed M. W. Ablation treatment for Barrett oesophagus: what depth of tissue destruction is needed? J Clin Pathol. 1999 Jul;52(7):509–512. doi: 10.1136/jcp.52.7.509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barham C. P., Jones R. L., Biddlestone L. R., Hardwick R. H., Shepherd N. A., Barr H. Photothermal laser ablation of Barrett's oesophagus: endoscopic and histological evidence of squamous re-epithelialisation. Gut. 1997 Sep;41(3):281–284. doi: 10.1136/gut.41.3.281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barr H., Shepherd N. A., Dix A., Roberts D. J., Tan W. C., Krasner N. Eradication of high-grade dysplasia in columnar-lined (Barrett's) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX. Lancet. 1996 Aug 31;348(9027):584–585. doi: 10.1016/s0140-6736(96)03054-1. [DOI] [PubMed] [Google Scholar]
  4. Brand D. L., Ylvisaker J. T., Gelfand M., Pope C. E., 2nd Regression of columnar esophageal (Barrett's) epithelium after anti-reflux surgery. N Engl J Med. 1980 Apr 10;302(15):844–848. doi: 10.1056/NEJM198004103021506. [DOI] [PubMed] [Google Scholar]
  5. Cameron A. J., Ott B. J., Payne W. S. The incidence of adenocarcinoma in columnar-lined (Barrett's) esophagus. N Engl J Med. 1985 Oct 3;313(14):857–859. doi: 10.1056/NEJM198510033131404. [DOI] [PubMed] [Google Scholar]
  6. Dooner J., Cleator I. G. Selective management of benign esophageal strictures. Am J Gastroenterol. 1982 Mar;77(3):172–177. [PubMed] [Google Scholar]
  7. Gossner L., May A., Stolte M., Seitz G., Hahn E. G., Ell C. KTP laser destruction of dysplasia and early cancer in columnar-lined Barrett's esophagus. Gastrointest Endosc. 1999 Jan;49(1):8–12. doi: 10.1016/s0016-5107(99)70438-4. [DOI] [PubMed] [Google Scholar]
  8. Gossner L., Stolte M., Sroka R., Rick K., May A., Hahn E. G., Ell C. Photodynamic ablation of high-grade dysplasia and early cancer in Barrett's esophagus by means of 5-aminolevulinic acid. Gastroenterology. 1998 Mar;114(3):448–455. doi: 10.1016/s0016-5085(98)70527-x. [DOI] [PubMed] [Google Scholar]
  9. Haggitt R. C. Barrett's esophagus, dysplasia, and adenocarcinoma. Hum Pathol. 1994 Oct;25(10):982–993. doi: 10.1016/0046-8177(94)90057-4. [DOI] [PubMed] [Google Scholar]
  10. Hamilton S. R., Smith R. R. The relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett's esophagus. Am J Clin Pathol. 1987 Mar;87(3):301–312. doi: 10.1093/ajcp/87.3.301. [DOI] [PubMed] [Google Scholar]
  11. Miros M., Kerlin P., Walker N. Only patients with dysplasia progress to adenocarcinoma in Barrett's oesophagus. Gut. 1991 Dec;32(12):1441–1446. doi: 10.1136/gut.32.12.1441. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Overholt B. F., Panjehpour M., Haydek J. M. Photodynamic therapy for Barrett's esophagus: follow-up in 100 patients. Gastrointest Endosc. 1999 Jan;49(1):1–7. doi: 10.1016/s0016-5107(99)70437-2. [DOI] [PubMed] [Google Scholar]
  13. Overholt B., Panjehpour M., Tefftellar E., Rose M. Photodynamic therapy for treatment of early adenocarcinoma in Barrett's esophagus. Gastrointest Endosc. 1993 Jan-Feb;39(1):73–76. doi: 10.1016/s0016-5107(93)70017-6. [DOI] [PubMed] [Google Scholar]
  14. Regula J., MacRobert A. J., Gorchein A., Buonaccorsi G. A., Thorpe S. M., Spencer G. M., Hatfield A. R., Bown S. G. Photosensitisation and photodynamic therapy of oesophageal, duodenal, and colorectal tumours using 5 aminolaevulinic acid induced protoporphyrin IX--a pilot study. Gut. 1995 Jan;36(1):67–75. doi: 10.1136/gut.36.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Riddell R. H., Goldman H., Ransohoff D. F., Appelman H. D., Fenoglio C. M., Haggitt R. C., Ahren C., Correa P., Hamilton S. R., Morson B. C. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol. 1983 Nov;14(11):931–968. doi: 10.1016/s0046-8177(83)80175-0. [DOI] [PubMed] [Google Scholar]
  16. Sampliner R. E., Fennerty B., Garewal H. S. Reversal of Barrett's esophagus with acid suppression and multipolar electrocoagulation: preliminary results. Gastrointest Endosc. 1996 Nov;44(5):532–535. doi: 10.1016/s0016-5107(96)70004-4. [DOI] [PubMed] [Google Scholar]
  17. Sampliner R. E., Hixson L. J., Fennerty M. B., Garewal H. S. Regression of Barrett's esophagus by laser ablation in an anacid environment. Dig Dis Sci. 1993 Feb;38(2):365–368. doi: 10.1007/BF01307557. [DOI] [PubMed] [Google Scholar]
  18. Skinner D. B., Walther B. C., Riddell R. H., Schmidt H., Iascone C., DeMeester T. R. Barrett's esophagus. Comparison of benign and malignant cases. Ann Surg. 1983 Oct;198(4):554–565. doi: 10.1097/00000658-198310000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Spechler S. J., Robbins A. H., Rubins H. B., Vincent M. E., Heeren T., Doos W. G., Colton T., Schimmel E. M. Adenocarcinoma and Barrett's esophagus. An overrated risk? Gastroenterology. 1984 Oct;87(4):927–933. [PubMed] [Google Scholar]

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