Background: There are few data available comparing endoscopic ablation methods for Barrett's esophagus with high-grade
Objective: To determine differences in symptoms and complications associated with endoscopic ablation.
Design: Prospective observational study.
Setting: Two tertiary care centers in USA.
Patients: Consecutive patients with BE-HGD
Interventions: In this pilot study, symptoms profile data were collected for BE-HGD patients among 3 endoscopic
ablation methods: porfimer sodium photodynamic therapy, radiofrequency ablation and low-pressure liquid nitrogen
Main Outcome Measurements: Symptom profiles and complications from the procedures were assessed 1-8 weeks after
Results: Ten BE-HGD patients were treated with each ablation modality (30 patients total; 25 men, median age: 69
years (range 53-81). All procedures were performed in the clinic setting and none required subsequent hospitalization.
The most common symptoms among all therapies were chest pain, dysphagia and odynophagia. More patients (n=8) in
the porfimer sodium photodynamic therapy group reported weight loss compared to radio-frequency ablactation (n=2)
and cryotherapy (n=0). Four patients in the porfimer sodium photodynamic therapy group developed phototoxicity
requiring medical treatment. Strictures, each requiring a single dilation, were found in radiofrequency ablactation (n=1)
and porfimer sodium photodynamic therapy (n=2) patients.
Limitations: Small sample size, non-randomized study.
Conclusions: These three endoscopic therapies are associated with different types and severity of post-ablation
symptoms and complications.
Photodynamic therapy with porfimer sodium (PS) is a treatment option for high grade dysplasia associated with Barrett's
esophagus. This study sought to investigate the optical properties of Barrett's dysplasia that may be useful in light
dosimetry planning and to determine the effect of PS on tissue absorption and scattering. Fiber optic reflectance spectra
were collected before and 48 hours after administration of 2 mg/kg PS. Mucosal biopsies were collected at the same
locations. According to Monte Carlo analysis, the fiber optic probe sampled only the mucosal layer. A mathematical fit
of the reflectance spectra was performed as a function of blood volume fraction, oxygen saturation and scattering. The
average calculated blood volume was 100% higher in Barrett's tissue than normal esophageal tissue. The average
scattering slope from 620 to 750 nm was 26% higher for Barrett's dysplasia than normal esophageal tissue, indicating an
increase in the size of scattering particles. The difference in the scattering amplitude was not statistically significant,
suggesting no significant increase in the number of scattering particles. PS tissue content was determined with extraction
methods. Changes in the scattering slope due to PS sensitization were observed; however they were not proportional to
the extracted PS concentration.