Invasive carcinoma after endoscopic ablative therapy for high-grade dysplasia in Barrett's oesophagus

被引:15
作者
van Hillegersberg, R
Haringsma, J
ten Kate, FJW
Tytgat, GNJ
van Lanschot, JJB
机构
[1] Acad Med Ctr, Dept Surg, NL-1100 DD Amsterdam, Netherlands
[2] Acad Med Ctr, Dept Gastroenterol, NL-1100 DD Amsterdam, Netherlands
[3] Acad Med Ctr, Dept Pathol, NL-1100 DD Amsterdam, Netherlands
关键词
Barrett's oesophagus; photodynamic therapy; dysplasia; adenocarcinoma;
D O I
10.1159/000072713
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background. Patients with high-grade dysplasia (HGD) in Barrett's oesophagus carry a significant risk of developing adenocarcinoma. Endoscopic mucosal resection (EMR) and photodynamic therapy (PDT) aim at the radical ablation of the dysplastic area. Methods: We used EMR to resect the macroscopic area of dysplastic mucosa followed by PDT to eliminate residual disease. PDT was performed after oral administration of 5-aminolevulinic acid (ALA, 40 mg/kg), using fractionated illumination 3 and 6 h later with 630 nm light at 100 J/cm(2) through an endoscopic balloon diffuser. Results: We report 2 patients who developed adenocarcinoma shortly after incomplete endoscopic ablation of Barrett's epithelium. In a 61-year-old man with HGD in 8-cm Barrett's segment, HGD persisted 3 months after treatment. The oesophagectomy specimen showed a 2.3-cm pT2N0M0 adenocarcinoma in Barrett's. In a 69-year-old woman with extensive HGD in 5-cm Barrett's, HGD persisted after 3 PDT sessions in 1 year. Adenocarcinoma occurred 6 months after treatment. The oesophagectomy showed a pT1bN0M0 adenocarcinoma and extensive multifocal HGD in Barrett's. Conclusions: The combination of EMR and PDT may be a promising option for local treatment of patients with HGD in Barrett's oesophagus, provided all dysplastic tissue can be removed. Currently it should be offered only to patients who are willing to participate in a clinical trial with an intensive endoscopic follow-up programme. Copyright (C) 2003 S. Karger AG, Basel.
引用
收藏
页码:440 / 444
页数:5
相关论文
共 40 条
  • [1] Ackroyd R, 1999, PHOTOCHEM PHOTOBIOL, V70, P656, DOI 10.1562/0031-8655(1999)070<0656:AAPODB>2.3.CO
  • [2] 2
  • [3] Photodynamic therapy for dysplastic Barrett's oesophagus: a prospective, double blind, randomised, placebo controlled trial
    Ackroyd, R
    Brown, NJ
    Davis, MF
    Stephenson, TJ
    Marcus, SL
    Stoddard, CJ
    Johnson, AG
    Reed, MWR
    [J]. GUT, 2000, 47 (05) : 612 - 617
  • [4] Eradication of high-grade dysplasia in columnar-lined (Barrett's) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX
    Barr, H
    Shepherd, NA
    Dix, A
    Roberts, DJH
    Tan, WC
    Krasner, N
    [J]. LANCET, 1996, 348 (9027) : 584 - 585
  • [5] The histopathology of treated Barrett's esophagus - Squamous reepithelialization after acid suppression and laser and photodynamic therapy
    Biddleston, LR
    Barham, CP
    Wilkinson, SP
    Barr, H
    Shepherd, NA
    [J]. AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1998, 22 (02) : 239 - 245
  • [6] Endoscopic Laser Ablation of Nondysplastic Barrett's Epithelium: Is It Worthwhile?
    Bonavina L.
    Ceriani C.
    Carazzone A.
    Segalin A.
    Ferrero S.
    Peracchia A.
    [J]. Journal of Gastrointestinal Surgery, 1999, 3 (2) : 194 - 199
  • [7] Bremner C G, 1998, Dis Esophagus, V11, P1
  • [8] Byrne JP, 1998, AM J GASTROENTEROL, V93, P1810
  • [9] Edwards MJ, 1996, ANN SURG, V223, P585, DOI 10.1097/00000658-199605000-00014
  • [10] Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus
    Ell, C
    May, A
    Gossner, L
    Pech, O
    Günter, E
    Mayer, G
    Henrich, R
    Vieth, M
    Müller, H
    Seitz, G
    Stolte, M
    [J]. GASTROENTEROLOGY, 2000, 118 (04) : 670 - 677