Overholt B F, Panjehpour M, Haydek J M
Laser Department, Thompson Cancer Survival Center, Knoxville, Tennessee, USA.
Gastrointest Endosc. 1999 Jan;49(1):1-7. doi: 10.1016/s0016-5107(99)70437-2.
This report presents clinical results of photodynamic therapy in patients with Barrett's esophagus and dysplasia or superficial esophageal cancer.
One hundred patients including 13 with superficial cancers were treated. Light (630 nm) was endoscopically delivered to the esophageal mucosa by a diffuser or a windowed esophageal centering balloon. Nd:YAG laser was required to ablate small residual areas of Barrett's mucosa during-long-term follow-up. Patients were maintained on omeprazole and were followed for 4 to 84 months (mean 19 months).
Conversion of approximately 75% to 80% of treated Barrett's mucosa to normal squamous epithelium was found in all patients; complete elimination of Barrett's mucosa was noted in 43 patients. Dysplasia was eliminated in 78 patients. Dysplasia developed during follow-up in 11 of 48 patients in untreated Barrett's mucosa requiring additional therapy. Ten of the 13 malignancies were ablated. Esophageal strictures occurred in 34%. Use of longer centering balloons reduced the incidence of strictures.
Photodynamic therapy alone or with Nd:YAG laser thermal ablation combined with long-term acid inhibition provides an effective endoscopic therapy to (1) eliminate Barrett's mucosal dysplasia and superficial esophageal cancer and (2) reduce the extent of and, in some cases, eliminate Barrett's mucosa.
本报告介绍了光动力疗法治疗巴雷特食管伴发育异常或浅表食管癌患者的临床结果。
对100例患者进行了治疗，其中包括13例浅表癌患者。通过扩散器或带窗口的食管对中球囊在内镜下将光（630纳米）输送至食管黏膜。在长期随访期间，需要用钕钇铝石榴石激光消融巴雷特黏膜的小残留区域。患者持续服用奥美拉唑，并随访4至84个月（平均19个月）。
所有患者中约75%至80%的治疗后巴雷特黏膜转变为正常鳞状上皮；43例患者的巴雷特黏膜完全消除。78例患者的发育异常被消除。在未治疗的巴雷特黏膜中，48例患者中有11例在随访期间出现发育异常，需要额外治疗。13例恶性肿瘤中有10例被消融。食管狭窄发生率为34%。使用更长的对中球囊可降低狭窄发生率。
单独使用光动力疗法或与钕钇铝石榴石激光热消融联合长期抑制胃酸，可提供一种有效的内镜治疗方法，以（1）消除巴雷特黏膜发育异常和浅表食管癌，（2）减少巴雷特黏膜的范围，在某些情况下消除巴雷特黏膜。
