Peters Femke P, Kara Mohammed A, Rosmolen Wilda D, Aalders Maurice C G, Ten Kate Fiebo J W, Bultje Bert C, Krishnadath Kausilia K, Fockens Paul, van Lanschot Jan J B, van Deventer Sander J H, Bergman Jacques J G H M
Department of Gastroenterology and Hepatology Laser Center, Amsterdam, The Netherlands.
Gastrointest Endosc. 2005 Apr;61(4):506-14. doi: 10.1016/s0016-5107(05)00063-5.
The aim of this study was to prospectively evaluate endoscopic resection (ER) combined with photodynamic therapy (PDT) for the treatment of selected patients with early neoplasia in Barrett's esophagus.
Patients with Barrett's esophagus and neoplastic lesions <2 cm in diameter and no sign of submucosal infiltration, positive lymph nodes, or distant metastasis underwent diagnostic ER (cap technique). Patients with a T1sm tumor in the resection specimen were referred for surgery; those with a T1m or a less invasive tumor underwent additional endoscopic therapy (ER, PDT, and/or argon plasma coagulation [APC]), or they were followed. PDT was performed with 5-aminolevulinic acid and a light dose of 100 J/cm 2 at lambda = 632 nm.
Thirty-three patients underwent diagnostic ER. Endoscopic treatment was not performed in 5 patients, who underwent surgery (4 T1sm; 1, patient preference). Five patients were immediately entered into a follow-up protocol, and 23 received additional endoscopic treatment (13 additional ER, 19 PDT, 3 APC). Endoscopic treatment was successful in 26/28 patients; no severe complication was observed. During follow-up (median 19 months, range 13-24 months), 5/26 patients had a recurrence of high-grade dysplasia: all were successfully re-treated with ER. At the end of follow-up, 26/33 originally enrolled patients (79%) and 26/28 endoscopically treated patients (93%) were in local remission.
Endoscopic therapy is safe and effective for selected patients with early stage neoplasia in Barrett's esophagus.
本研究的目的是前瞻性评估内镜切除术（ER）联合光动力疗法（PDT）治疗巴雷特食管早期肿瘤的特定患者。
巴雷特食管且肿瘤病变直径<2 cm、无黏膜下浸润、淋巴结阳性或远处转移迹象的患者接受诊断性ER（套扎技术）。切除标本中为T1sm肿瘤的患者转至外科手术；T1m或侵袭性较小肿瘤的患者接受额外的内镜治疗（ER、PDT和/或氩离子凝固术[APC]），或进行随访。PDT使用5-氨基酮戊酸，在λ = 632 nm时光剂量为100 J/cm²。
33例患者接受了诊断性ER。5例患者未进行内镜治疗，而是接受了手术（4例T1sm；1例，患者选择）。5例患者立即进入随访方案，23例接受了额外的内镜治疗（13例额外ER，19例PDT，3例APC）。28例患者中有26例内镜治疗成功；未观察到严重并发症。随访期间（中位时间19个月，范围13 - 24个月），26例患者中有5例高级别异型增生复发：所有患者均通过ER成功再次治疗。随访结束时，最初纳入的33例患者中有26例（79%）以及28例接受内镜治疗的患者中有26例（93%）处于局部缓解状态。
内镜治疗对于巴雷特食管早期肿瘤的特定患者是安全有效的。
