Photodynamic therapy of high grade dysplasia/intramucosal carcinoma in Barrett's esophagus — 30 months follow up

2001 ◽  
Vol 53 (5) ◽  
pp. AB144 ◽  
Keyword(s):  
Photodynamic Therapy ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
High Grade Dysplasia ◽  
High Grade

scholarly journals Photodynamic Therapy in Barrett’s Esophagus: Results of Treatment of 17 Patients

2006 ◽  
Vol 20 (4) ◽  
pp. 261-264 ◽  
Author(s):  
Alan A Weiss ◽  
Holly AR Wiesinger ◽  
David Owen
Keyword(s):  
Photodynamic Therapy ◽  
Barrett’S Esophagus ◽  
Esophageal Adenocarcinoma ◽  
Barrett's Esophagus ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Early Adenocarcinoma

BACKGROUND: Barrett’s esophagus (BE) with dysplasia may progress to esophageal adenocarcinoma. Photodynamic therapy is a promising treatment for BE.OBJECTIVE: To determine if photodynamic therapy is an acceptable alternative to esophagectomy in BE patients with high-grade dysplasia or early adenocarcinoma.METHODS: Seventeen patients were treated with photodynamic therapy for BE and high-grade dysplasia or early esophageal adenocarcinoma. Patients with residual Barrett’s epithelium were treated with supplemental argon plasma coagulation or potassium titanyl phosphate laser. Patients underwent follow-up endoscopy three, six, nine and 12 months post-treatment, then every six to 12 months. Mean follow-up was 21 months.RESULTS: High-grade dysplasia or early adenocarcinoma was completely eliminated in nine of 15 (60%) patients. High-grade dysplasia was downgraded in one patient, persisted in one patient and progressed in four patients. Two patients with early esophageal adenocarcinoma were nonresponders. Complications included stricture, sunburn, urticaria, small pleural effusions, esophageal spasm and transient atrial fibrillation.CONCLUSIONS: Photodynamic therapy with supplemental ablation is a good, noninvasive therapy for elimination of high-grade dysplasia and early adenocarcinoma in BE. Failure to eliminate dysplastic epithelium occurred in 40% of the patients, thereby necessitating careful follow-up.

scholarly journals Photodynamic Therapy for Barrett’s Esophagus with High-Grade Dysplasia: A Cost-Effectiveness Analysis

2007 ◽  
Vol 21 (4) ◽  
pp. 217-222 ◽  
Author(s):  
Dan Comay ◽  
Gord Blackhouse ◽  
Ron Goeree ◽  
David Armstrong ◽  
John K Marshall
Keyword(s):  
Photodynamic Therapy ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Barrett’S Esophagus ◽  
Probabilistic Analysis ◽  
Barrett's Esophagus ◽  
Cost Effective ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Male Patients

OBJECTIVES: To assess the cost-effectiveness of photodynamic therapy (PDT) and esophagectomy (ESO) relative to surveillance (SURV) for patients with Barrett’s esophagus (BE) and high-grade dysplasia (HGD).METHODS: A Markov decision tree was constructed to estimate costs and health outcomes of PDT, ESO and SURV in a hypothetical cohort of male patients, 50 years of age, with BE and HGD. Outcomes included unadjusted life-years (LYs) and quality-adjusted LYs (QALYs). Direct medical costs (2003 CDN$) were measured from the perspective of a provincial ministry of health. The time horizon for the model was five years (cycle length three months), and costs and outcomes were discounted at 3%. Model parameters were assigned unique distributions, and a probabilistic analysis with 10,000 Monte Carlo simulations was performed.RESULTS: SURV was the least costly strategy, followed by PDT and ESO, but SURV was also the least effective. In terms of LYs, the incremental cost-effectiveness ratios were $814/LY for PDT versus SURV and $3,397/LY for ESO versus PDT. PDT dominated ESO for QALYs in the base-case. The incremental cost-effectiveness ratio of PDT versus SURV was $879/QALY. In probabilistic analysis, PDT was most likely to be cost-effective at willingness-to-pay (WTP) values between $100/LY and $3,500/LY, and ESO was most likely to be cost-effective for WTP values over $3500/LY. For quality-adjusted survival, PDT was most likely to be cost-effective for all WTP thresholds above $1,000/QALY. The likelihood that PDT was the most cost-effective strategy reached 0.99 at a WTP ceiling of $25,000/QALY.CONCLUSIONS: In male patients with BE and HGD, PDT and ESO are cost-effective alternatives to SURV.

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