Photodynamic therapy for Barrett's esophagus.

In summary, in a group of 55 patients with Barrett's esophagus and dysplasia, the authors have reported the ablation of seven superficial cancers, the elimination of dysplasia in 42 of the 55 patients, the complete elimination of Barrett's mucosa in 16 patients, and the reduction of the extent of Barrett's mucosa in all patients who were treated with PDT and were maintained on long-term omeprazole. Repeated PDT sessions were required in some patients to accomplish elimination of dysplasia. Esophageal strictures occurred in 53% of patients, but were treated satisfactorily with dilation. Current results using 5- and 7-cm centering balloons has shown a dramatic reduction in the incidence of stricture formation. Mucosal injury with these balloons is less than with diffusers or shorter balloons that require overlapping of treated areas. The authors are carefully following the patients treated with longer PDT balloons to evaluate the long-term effects on dysplasia. Lugol's staining is an important technique to identify residual patches of Barrett's mucosa following PDT. Small residual patches of Barrett's mucosa can be successfully destroyed with Nd: YAG laser therapy. The authors' results indicate that PDT alone or in combination with thermal ablation can eliminate superficial cancers, dysplasia, and Barrett's mucosa in many patients with Barrett's esophagus.