Original Article

Photodynamic Therapy and Endoscopic Mucosal Resection for Barrett’s Dysplasia and Early Esophageal Adenocarcinoma

Authors: H C. Wolfsen, MD, FACG, FACP, Lois L. Hemminger, ARNP, Massimo Raimondo, MD, Timothy A. Woodward, MD

Abstract

Background: Endoscopic mucosal resection (EMR) and endoscopic ablation with porfimer sodium photodynamic therapy (PDT) have recently been combined to improve the accuracy of histologic staging and remove superficial carcinomas.


Materials and Methods: All patients with Barrett’s esophagus and high-grade dysplasia were evaluated with computed tomography and endosonography. Patients with nodular or irregular folds underwent EMR followed by PDT.


Results: In three patients, endoscopic mucosal resection upstaged the diagnosis to mucosal adenocarcinoma (T1N0M0). PDT successfully ablated the remaining glandular mucosa. Complications were limited to transient chest discomfort and odynophagia.


Conclusions: The use of EMR resection in Barrett’s high-grade dysplasia patients with mucosal irregularities resulted in histologic upstaging to mucosal adenocarcinoma, requiring higher laser light doses for PDT. PDT after EMR appears to be safe and effective for the complete elimination of Barrett’s mucosal adenocarcinoma. EMR should be strongly considered for Barrett’s dysplasia patients being evaluated for endoscopic ablation therapy.


Key Points


* The past two decades have witnessed an alarming increase in patients diagnosed with Barrett’s esophagus and esophageal adenocarcinoma.


* Photodynamic therapy using porfimer sodium has recently been approved for use in patients with Barrett’s high-grade dysplasia, as an alternative to surgical resection.


* Mucosal irregularities occurring within the Barrett’s glandular mucosa are suspicious for the presence of invasive neoplasm.


* Endoscopic mucosal resection of these mucosal Barrett’s irregularities detected mucosal adenocarcinoma.


* Photodynamic therapy after endoscopic mucosal resection appears to be safe and effective for the complete elimination of Barrett’s mucosal adenocarcinoma.

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