Photodynamic ablation and argon-plasma coagulation of premalignant and early-stage malignant lesions of the oesophagus - An alternative to surgery?

Eleven patients with high-grade mucosal dysplasia in a columnar-lined oesop hagus and 2 patients with a squamous carcinoma (uT1) underwent photodynamic therapy (PDT) and argon-plasma coagulation (APC). For PDT, 5-aminolevulini c acid (5-ALA) was given orally (60 mg/kg) and treated endoscopically with a light dose of 150 J/cm(2) (100 mW/cm(2)) at 635 nm 4-6 h later. A second PDT was performed under the same conditions 2-3 weeks later. Patients who r eceived APC were treated 4 times on average to reach radical Barrett mucosa eradication. All patients were consistently given medication to suppress a cid production. No complications occurred in either group. Follow-up endosc opies and multiple biopsies for 3-42 months showed squamous regeneration in the dysplastic columnar-lined oesophagus in all 11 patients. Two patients with squamous carcinoma were found to have a recurrence 9 and 12 months lat er. PDT with 5-ALA-induced endogenous porphyrins, as well as APC combined w ith omeprazole protection, can eradicate superficial high-grade dysplastic mucosa in Barrett's oesophagus, However, we did not succeed in destroying a manifest carcinoma.