Ackroyd R, Brown N J, Davis M F, Stephenson T J, Marcus S L, Stoddard C J, Johnson A G, Reed M W
Division of Surgical and Anaesthetic Sciences, University of Sheffield, Sheffield, UK.
Gut. 2000 Nov;47(5):612-7. doi: 10.1136/gut.47.5.612.
Photodynamic therapy (PDT) is a treatment in which cell damage is achieved by the action of light on a photosensitizing agent. We have assessed the potential use of PDT in the ablation of Barrett's oesophagus.
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.
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.
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.
光动力疗法（PDT）是一种通过光作用于光敏剂来实现细胞损伤的治疗方法。我们评估了光动力疗法在巴雷特食管消融中的潜在应用。
36例接受奥美拉唑抑酸治疗的发育异常巴雷特食管患者被随机分为两组，一组口服30mg/kg的5-氨基酮戊酸（ALA），另一组口服安慰剂，4小时后进行激光内镜检查。在1、6、12和24个月时进行随访内镜检查。
ALA组的18例患者中，16例有反应（治疗区域面积中位数减少30%；范围0-60%）。安慰剂组中，2例患者面积减少10%，16例无变化（中位数0%；范围0-10%；治疗组与安慰剂组比较，p<0.001）。光动力疗法组的任何患者治疗区域内的柱状上皮均未见发育异常。然而，安慰剂组有12例患者存在持续性低级别发育异常（p<0.001）。无短期或长期的严重副作用。治疗效果维持长达24个月。
这是第一项关于光动力疗法治疗巴雷特食管的随机对照试验。结果表明，ALA诱导的光动力疗法可安全有效地消融低级别发育异常上皮。
