Photodynamic therapy (
PDT) was one of the earliest ablative techniques applied to
Barrett's esophagus. The rationale for this use was the ability to treat large amounts of esophageal mucosa in a single rapid application. Additionally,
PDT has the ability to treat early
carcinoma and dysplastic tissue. Because a small
carcinoma in dysplastic
Barrett's esophagus cannot not be excluded,
PDT therapy is a reasonable treatment in this setting. The treatment involves the use of a light and
drug combination that must be administered with close attention to dosimetry, since tissue effects of the
therapy are delayed and cannot be observed at the time of treatment.
Drug administration of
sodium porfimer should precede photoradiation by 48 hours. Overall results with this treatment have been good. Case series have established a success rate of 88% to 100% in elimination of high-grade dysplasia. The only randomized multi-center prospective trial in the treatment of
Barrett's esophagus with high-grade dysplasia has established that the treatment eliminates high-grade dysplasia better than administration of
proton pump inhibitors alone. Unfortunately, there are significant adverse events, including cutaneous photosensitivity, odynophagia,
stricture formation, and lack of response.