Endoscopy 2005; 37(10): 999-1005
DOI: 10.1055/s-2005-870352
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Curative Treatment for High-Grade Intraepithelial Neoplasia in Barrett’s Esophagus

A.  Behrens1 , A.  May1 , L.  Gossner1 , E.  Günter1 , O.  Pech1 , M.  Vieth2 , M.  Stolte2 , G.  Seitz3 , C.  Ell1
  • 1Department of Internal Medicine II, HSK, Wiesbaden, Germany
  • 2Institute of Pathology, Bayreuth, Germany
  • 3Institute of Pathology, Bamberg, Germany
Weitere Informationen

Publikationsverlauf

Submitted 25 January 2005

Accepted after Revision 9 May 2005

Publikationsdatum:
27. September 2005 (online)

Background and Study Aims: The incidence of premalignant and malignant lesions in specialized intestinal metaplasia of the esophagus has increased dramatically in the industrialized world in recent years. This report evaluates the efficacy and safety of local endoscopic therapy for high-grade intraepithelial neoplasia (HGIN) in Barrett’s esophagus.
Patients and Methods: Over a 5-year period between October 1996 and September 2001, a total of 379 patients were referred with a suspicion of early Barrett’s cancer. In a prospective study, 44 patients with HGIN in Barrett’s esophagus were selected for local endoscopic treatment. Endoscopic resection was carried out in 14 patients in whom the HGIN was re-detectable, and 27 patients in whom the HGIN was not re-detectable underwent photodynamic therapy (PDT). Endoscopic resection and PDT were combined in three patients.
Results: Complete remission was achieved in 43 of the 44 patients (97.7 %). No major complications occurred. A mean of 1 session was needed to achieve complete local remission. During a mean follow-up period of 36 months (range 7 - 61 months), recurrent or metachronous lesions were observed in six patients (17.1 %), all of whom received a second successful endoscopic treatment.
Conclusions: Endoscopic therapy is a safe alternative treatment regimen for HGIN in Barrett’s esophagus, providing a middle way between the widely promulgated options of a ”watch-and-wait” policy and radical esophagectomy.

References

  • 1 Bytzer P, Christensen P B, Damkier P. et al . Adenocarcinoma of the esophagus and Barrett’s esophagus: a population-based study.  Am J Gastroenterol. 1999;  94 86-91
  • 2 Heitmiller R F, Redmond M, Hamilton S R. Barrett’s esophagus with high-grade dysplasia: an indication for prophylactic esophagectomy.  Ann Surg. 1996;  224 66-71
  • 3 Stein H J, Feith M, Mueller J. et al . Limited resection for early adenocarcinoma in Barrett’s esophagus.  Ann Surg. 2000;  232 733-742
  • 4 Sampliner R E. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. The Practice Parameters Committee of the American College of Gastroenterology.  Am J Gastroenterol. 1998;  93 1028-1032
  • 5 The Society for Surgery of the Alimentary Tract (SSAT), American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE) Consensus Panel . Management of Barrett’s esophagus.  J Gastrointest Surg. 2000;  4 115-116
  • 6 Pech O, Nagy C D, Gossner L. et al . Photodynamic therapy of human Barrett’s cancer using 5-aminolaevulinic acid-induced protoporphyrin IX: an in-vivo dosimetry study in athymic nude mice.  Eur J Gatroenterol Hepatol.. 2002;  14 657-662
  • 7 Ell C, May A, Wurster H. The first reusable multiple-band ligator for endoscopic hemostasis of variceal bleeding, nonvariceal bleeding and mucosal resection.  Endoscopy. 1999;  31 738-740
  • 8 May A, Gossner L, Behrens A. et al . A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus.  Gastrointest Endosc. 2003;  58 167-175
  • 9 Gossner L, Stolte M, Sroka R. et al . Photodynamic ablation of high-grade dysplasia and early cancer in Barrett’s esophagus by means of 5-aminolevulinic acid.  Gastroenterology. 1998;  114 448-455
  • 10 May A, Gossner L, Günter E. et al . Local treatment of early cancer in short Barrett’s esophagus by means of argon plasma coagulation: initial experience.  Endoscopy. 1999;  31 497-500
  • 11 Gossner L, May A, Stolte M. et al . KTP laser destruction of dysplasia and early cancer in columnar-lined Barrett’s esophagus.  Gastrointest Endosc. 1999;  49 8-12
  • 12 Hamilton S R, Aaltonen L A (eds). Pathology and genetics of tumours of the digestive system. World Health Organization classification of tumours. Lyon; IARC Press 2000
  • 13 Overholt B J, Panjehpour M, Halberg D L. Photodynamic therapy for Barrett’s esophagus with dysplasia and/or early stage carcinoma: long-term results.  Gastrointest Endosc. 2003;  58 183-188
  • 14 Sharma P. Controversies in Barrett’s esophagus: management of high-grade dysplasia.  Semin Gastrointest Dis. 2001;  12 26-32
  • 15 Weston A P, Sharma P, Topalovski M. et al . A. Long-term follow-up of Barrett’s high-grade dysplasia.  Am J Gastroenterol. 2000;  95 1888-1893
  • 16 Reid B J, Levine D S, Longton G. et al . Predictors of progression to cancer in Barrett’s esophagus: baseline history and flow cytometry identify low- and high-risk patient subsets.  Am J Gastroenterol. 2000;  95 1669-1676
  • 17 Schnell T G, Sontag S J, Chejfec G. et al . Long-term nonsurgical management of Barrett’s esophagus with high-grade dysplasia.  Gastroenterology. 2001;  120 1607-1619
  • 18 Montgomery E, Goldblum J R, Greenson J K. et al . Dysplasia as a predictive marker for invasive carcinoma in Barrett esophagus: a follow-up study based on 138 cases from a diagnostic variability study.  Hum Pathol. 2001;  32 379-388
  • 19 May A, Gossner L, Pech O. et al . Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach.  Eur J Gastroenterol Hepatol. 2002;  14 1085-1091
  • 20 Montgomery E, Bronner M P, Goldblum J R. et al . Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation.  Hum Pathol. 2001;  32 368-378
  • 21 Buttar N S, Wang K K, Sebo T J. et al . Extent of high-grade dysplasia in Barrett’s esophagus correlates with risk of adenocarcinoma.  Gastroenterology. 2001;  120 1630-1639
  • 22 Dar M S, Goldblum J R, Rice T W. et al . Can extent of high grade dysplasia in Barrett’s oesophagus predict the presence of adenocarcinoma at oesophagectomy?.  Gut. 2003;  52 486-489
  • 23 Wolfsen H C, Woodward T A, Raimondo M. Photodynamic therapy for dysplastic Barrett esophagus and early esophageal adenocarcinoma.  Mayo Clin Proc. 2002;  77 1176-1181
  • 24 Weston A P, Sharma P. Neodymium:yttrium-aluminum garnet contact laser ablation of Barrett’s high grade dysplasia and early adenocarcinoma.  Am J Gastroenterol. 2002;  97 2998-3006
  • 25 Overholt B F, Panjehpour M. Photodynamic therapy for Barrett’s esophagus.  Gastrointest Endosc Clin N Am. 1997;  7 207-220
  • 26 Overholt B F, Lightdale C J, Wang K. et al .International multicenter, partially blinded, randomized study of the efficacy of photodynamic therapy (PDT) using porfimer sodium (POF) for the ablation of high-grade dysplasia (HGD) in Barrett’s esophagus (BE): results of 24-month follow-up. Paper presented at the 104th Annual Meeting of the American Gastroenterological Association (AGA) conference, Orlando, Florida, 18 - 21 May 2003. 
  • 27 Ackroyd R, Brown N J, Davis M F, Stephenson T J. et al . Photodynamic therapy for dysplastic Barrett's oesophagus: a prospective, double-blind randomised, placebo controlled trial.  Gut. 2000;  47 612-617
  • 28 Pech O, Nagy C D, Gossner L, May A, Ell C. et al . Photodynamic therapy of human Barrett's cancer using 5-aminolaevulinic acid-induced portoporphyrin IX: an in-vivo dosimetry study in athymic nude mice.  Eur J Gastroenterol Hepatol. 2002;  14 657-662

A. Behrens, M. D.

Dr. Horst-Schmidt-Kliniken · Innere Medizin II

Ludwig-Erhard-Straße 100 · 65199 Wiesbaden · Germany

Fax: +49-611-432418

eMail: ell.hsk-wiesbaden@arcor.de