KTP laser destruction of dysplasia and early cancer in columnar-lined Barrett's esophagus

Background: The rising incidence of esophageal adenocarcinoma in western co untries requires a new strategy in the management of dysplasia in Barren's esophagus, Esophagectomy, which has high morbidity and mortality rates, has been recommended to treat patients with severe dysplasia. Strictly superfi cial laser coagulation with tissue ablation therefore is a desirable option for the management of dysplasia in Barrett's esophagus because the tissue to be ablated is only about 2 mm thick, Potassium-titanyl-phosphate (KTP) l aser light with a wavelength of 532 nm is preferentially absorbed by hemogl obin and therefore combines excellent coagulation with limited tissue penet ration. We report first clinical results with KTP laser superficial vaporiz ation of dysplasia and early cancer in Barren's esophagus. Methods: Eight men and 2 women 43 to 84 years of age with short segments of Barrett's esophagus or traditional Barrett's esophagus and histologically proved low-grade (n = 4) and high-grade (n = 4) dysplasia or early adenocar cinoma (n = 2) were selected for this pilot study. For all patients thermal endoscopic destruction was conducted with a frequency-doubled neodymium:yt trium-aluminum-garnet (Nd:YAG) KTP laser system. Laser therapy was performe d by means of the free-beam method with coaxial insufflation of gas. An ave rage of 2.4 sessions per patient were required for ablation of the Barrett' s mucosa, Results: Two to three days after laser treatment the response of the ablate d mucosa was assessed with endoscopy and biopsy. Samples taken showed fibri noid necrosis of the mucosal layer. A complete response was obtained for al l 10 patients. Replacement by normal squamous cell epithelium was induced i n combination with acid suppression therapy of up to 80 mg omeprazole daily . No complications occurred. In two patients biopsy showed specialized muco sa beneath the restored squamous cell epithelial layer. Follow-up times wer e as long as 15 months (mean value 10.6 months). Conclusions: KTP laser destruction of Barren's esophagus induced mucosal re generation with normal squamous cell epithelium in combination with acid su ppression. Limitation of the depth of thermal destruction in Barrett's esop hagus minimizes risk for perforation or stricture formation. KTP laser abla tion of Barrett's esophagus seems to be feasible and safe in short segments of Barrett's esophagus with dysplasia or early cancer.