Weiss Alan A, Wiesinger Holly A R, Owen David
British Columbia Cancer Agency, Vancouver, British Columbia V5Z 4E6.
Can J Gastroenterol. 2006 Apr;20(4):261-4. doi: 10.1155/2006/954153.
Barrett's esophagus (BE) with dysplasia may progress to esophageal adenocarcinoma. Photodynamic therapy is a promising treatment for BE.
To determine if photodynamic therapy is an acceptable alternative to esophagectomy in BE patients with high-grade dysplasia or early adenocarcinoma.
Seventeen patients were treated with photodynamic therapy for BE and high-grade dysplasia or early esophageal adenocarcinoma. Patients with residual Barrett's epithelium were treated with supplemental argon plasma coagulation or potassium titanyl phosphate laser. Patients underwent follow-up endoscopy three, six, nine and 12 months post-treatment, then every six to 12 months. Mean follow-up was 21 months.
High-grade dysplasia or early adenocarcinoma was completely eliminated in nine of 15 (60%) patients. High-grade dysplasia was downgraded in one patient, persisted in one patient and progressed in four patients. Two patients with early esophageal adenocarcinoma were nonresponders. Complications included stricture, sunburn, urticaria, small pleural effusions, esophageal spasm and transient atrial fibrillation.
Photodynamic therapy with supplemental ablation is a good, noninvasive therapy for elimination of high-grade dysplasia and early adenocarcinoma in BE. Failure to eliminate dysplastic epithelium occurred in 40% of the patients, thereby necessitating careful follow-up.
伴有发育异常的巴雷特食管（BE）可能进展为食管腺癌。光动力疗法是一种有前景的BE治疗方法。
确定光动力疗法对于伴有高级别发育异常或早期腺癌的BE患者是否是食管切除术的可接受替代方案。
17例伴有高级别发育异常或早期食管腺癌的BE患者接受了光动力治疗。残留巴雷特上皮的患者接受了补充氩等离子体凝固或磷酸钛钾激光治疗。患者在治疗后3、6、9和12个月接受随访内镜检查，然后每6至12个月检查一次。平均随访时间为21个月。
15例患者中有9例（60%）的高级别发育异常或早期腺癌被完全消除。1例患者的高级别发育异常降级，1例患者持续存在，4例患者进展。2例早期食管腺癌患者无反应。并发症包括狭窄、晒伤、荨麻疹、少量胸腔积液、食管痉挛和短暂性心房颤动。
补充消融的光动力疗法是消除BE中高级别发育异常和早期腺癌的一种良好的非侵入性治疗方法。40%的患者未能消除发育异常上皮，因此需要仔细随访。
