Squamous Overgrowth Is Not a Safety Concern for Photodynamic Therapy for Barrett's Esophagus With High-Grade Dysplasia
| Autor: | Mary P, Bronner, Bergein F, Overholt, Shari L, Taylor, Rodger C, Haggitt, Kenneth K, Wang, J Steven, Burdick, Charles J, Lightdale, Michael, Kimmey, Hector R, Nava, Michael V, Sivak, Norman, Nishioka, Hugh, Barr, Marcia I, Canto, Norman, Marcon, Marcos, Pedrosa, Michael, Grace, Michelle, Depot, Roxan, Saidi |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class Biopsy Proton-pump inhibitor Gastroenterology Barrett Esophagus Esophagus Internal medicine medicine Carcinoma Humans Porfimer sodium Omeprazole Aged Hepatology medicine.diagnostic_test business.industry Middle Aged medicine.disease medicine.anatomical_structure Photochemotherapy Dysplasia Barrett's esophagus Dihematoporphyrin Ether Female business medicine.drug |
| Zdroj: | Gastroenterology. 136:56-64 |
| ISSN: | 0016-5085 |
| DOI: | 10.1053/j.gastro.2008.10.012 |
| Popis: | Background & Aims Photodynamic therapy with porfimer sodium combined with acid suppression (PHOPDT) is used to treat patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD). A 5-year phase 3 trial was conducted to determine the extent of squamous overgrowth of BE with HGD after PHOPDT. Methods Squamous overgrowth was compared in patients with BE with HGD randomly assigned (2:1) to receive PHOPDT (n = 138) or 20 mg omeprazole twice daily (n = 70). Patients underwent 4-quadrant jumbo esophageal biopsies every 2 cm throughout the pretreatment length of BE until 4 consecutive quarterly follow-up results were negative for HGD and then biannually up to 5 years or treatment failure. Endoscopies were reviewed by blinded gastroenterology pathologists. Results Histologic assessment of 33,658 biopsies showed no significant difference ( P > .05) in squamous overgrowth between groups when compared per patient (30% vs 33%) or per biopsy (0.5% vs 1.3%), or when the average number of biopsies with squamous overgrowth were compared per patient (0.48 vs 0.66). The highest grade of neoplasia per endoscopy was not found exclusively beneath squamous mucosa in any patient. Conclusions No difference was observed in squamous overgrowth between patients given PHOPDT plus omeprazole compared with only omeprazole. Squamous overgrowth did not obscure the most advanced neoplasia in any patient. Treatment of HGD with PHOPDT in patients with BE does not present a long-term risk of failure to detect subsquamous dysplasia or carcinoma. |
| Databáze: | OpenAIRE |
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