Advertisement

The Role of Photodynamic Therapy and Cryotherapy for the Management of Barrett’s Esophagus

  • Hope T. Jackson
  • Andrew S. WrightEmail author
Chapter

Abstract

Gastroesophageal reflux can cause injury to the normal stratified squamous epithelium of the esophagus. This injury may lead to replacement of the normal esophageal lining by a metaplastic columnar intestinal-like epithelium known as Barrett’s esophagus (BE). The clinical relevance of BE lies in its sequential progression from intestinal metaplasia (IM) to low-grade dysplasia (LGD), high-grade dysplasia (HGD), and, finally, invasive adenocarcinoma. In the absence of dysplasia, BE is associated with a low annual incidence of progression to adenocarcinoma (less than 0.5), but the incidence of progression to adenocarcinoma is up to five times as high when dysplasia is present. The management of BE with dysplasia and early cancer has shifted over the years, moving away from surgical resection (esophagectomy) to diagnostic and therapeutic endoscopy. Endoscopic therapy aims to remove the metaplastic or dysplastic tissue to a depth that destroys all the BE but minimizes damage to the submucosal layer of the esophagus to avoid stricture formation and transmural injury. Several treatment options—endoscopic mucosal resection (EMR) and tissue ablative therapies such as radiofrequency ablation (RFA), photodynamic therapy (PDT), and cryotherapy (CT)—have been recognized as safe and effective therapies to accomplish this and are now the standard of care in many expert centers. This chapter will focus on the role of photodynamic therapy and cryotherapy in the management of BE.

Keywords

Barrett’s esophagus Cryotherapy Photodynamic therapy Endoscopy Esophagus 

References

  1. 1.
    Pellegrini CA, Pohl D. High-grade dysplasia in Barrett’s esophagus: surveillance or operation? J Gastrointest Surg. 2000;4(2):131–4.CrossRefGoogle Scholar
  2. 2.
    Hvid-Jensen F, et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365(15):1375–83.CrossRefGoogle Scholar
  3. 3.
    Rastogi A, et al. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc. 2008;67(3):394–8.CrossRefGoogle Scholar
  4. 4.
    Sharma P, et al. Dysplasia and cancer in a large multicenter cohort of patients with Barrett’s esophagus. Clin Gastroenterol Hepatol. 2006;4(5):566–72.CrossRefGoogle Scholar
  5. 5.
    Desai TK, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut. 2012;61(7):970–6.CrossRefGoogle Scholar
  6. 6.
    Shakhatreh MH, et al. The incidence of esophageal adenocarcinoma in a national veterans cohort with Barrett’s esophagus. Am J Gastroenterol. 2014;109(12):1862–8. quiz 1861, 1869.CrossRefGoogle Scholar
  7. 7.
    Dunkin BL, Lyons C. Endoscopic therapies for Barrett’s esophagus. In: Swanstrom LL, Soper NJ, editors. Mastery of endoscopic and laparoscopic surgery. Philadelphia: Lippincott Williams & Wilkins; 2014.Google Scholar
  8. 8.
    Sappati Biyyani RS, Chak A. Barrett’s esophagus: review of diagnosis and treatment. Gastroenterol Rep (Oxf). 2013;1(1):9–18.CrossRefGoogle Scholar
  9. 9.
    Overholt BF, et al. Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett’s high-grade dysplasia. Gastrointest Endosc. 2007;66(3):460–8.CrossRefGoogle Scholar
  10. 10.
    Overholt BF, Panjehpour M, Haydek JM. Photodynamic therapy for Barrett’s esophagus: follow-up in 100 patients. Gastrointest Endosc. 1999;49(1):1–7.CrossRefGoogle Scholar
  11. 11.
    Overholt BF, et al. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized phase III trial. Gastrointest Endosc. 2005;62(4):488–98.CrossRefGoogle Scholar
  12. 12.
    Wang KK, Kim JY. Photodynamic therapy in Barrett’s esophagus. Gastrointest Endosc Clin N Am. 2003;13(3):483–9. viiCrossRefGoogle Scholar
  13. 13.
    Wolfsen HC, et al. Clinical experience of patients undergoing photodynamic therapy for Barrett’s dysplasia or cancer. Aliment Pharmacol Ther. 2004;20(10):1125–31.CrossRefGoogle Scholar
  14. 14.
    Wolfsen HC, Woodward TA, Raimondo M. Photodynamic therapy for dysplastic Barrett esophagus and early esophageal adenocarcinoma. Mayo Clin Proc. 2002;77(11):1176–81.CrossRefGoogle Scholar
  15. 15.
    Gossner L, et al. Photodynamic ablation of high-grade dysplasia and early cancer in Barrett’s esophagus by means of 5-aminolevulinic acid. Gastroenterology. 1998;114(3):448–55.CrossRefGoogle Scholar
  16. 16.
    Ackroyd R, et al. Photodynamic therapy for dysplastic Barrett’s oesophagus: a prospective, double blind, randomised, placebo controlled trial. Gut. 2000;47(5):612–7.CrossRefGoogle Scholar
  17. 17.
    Pech O, et al. Long-term results of photodynamic therapy with 5-aminolevulinic acid for superficial Barrett’s cancer and high-grade intraepithelial neoplasia. Gastrointest Endosc. 2005;62(1):24–30.CrossRefGoogle Scholar
  18. 18.
    Barr H, et al. Eradication of high-grade dysplasia in columnar-lined (Barrett’s) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX. Lancet. 1996;348(9027):584–5.CrossRefGoogle Scholar
  19. 19.
    Ackroyd R, et al. 5-Aminolevulinic acid photosensitization of dysplastic Barrett’s esophagus: a pharmacokinetic study. Photochem Photobiol. 1999;70(4):656–62.PubMedGoogle Scholar
  20. 20.
    Dunn JM, et al. A randomised controlled trial of ALA vs. Photofrin photodynamic therapy for high-grade dysplasia arising in Barrett’s oesophagus. Lasers Med Sci. 2013;28(3):707–15.CrossRefGoogle Scholar
  21. 21.
    Gray NA, Odze RD, Spechler SJ. Buried metaplasia after endoscopic ablation of Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2011;106(11):1899–908. quiz 1909.CrossRefGoogle Scholar
  22. 22.
    Van Laethem JL, et al. Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett’s oesophagus. Gut. 2000;46(4):574–7.CrossRefGoogle Scholar
  23. 23.
    Ertan A, et al. Photodynamic therapy vs radiofrequency ablation for Barrett’s dysplasia: efficacy, safety and cost-comparison. World J Gastroenterol. 2013;19(41):7106–13.CrossRefGoogle Scholar
  24. 24.
    Azarm A, et al. Endoscopic management of Barrett’s esophagus: advances in endoscopic techniques. Dig Dis Sci. 2012;57(12):3055–64.CrossRefGoogle Scholar
  25. 25.
    Greenwald BD, Dumot JA. Cryotherapy for Barrett’s esophagus and esophageal cancer. Curr Opin Gastroenterol. 2011;27(4):363–7.CrossRefGoogle Scholar
  26. 26.
    Johnston MH, et al. Cryoablation of Barrett’s esophagus: a pilot study. Gastrointest Endosc. 2005;62(6):842–8.CrossRefGoogle Scholar
  27. 27.
    Greenwald BD, et al. Safety, tolerability, and efficacy of endoscopic low-pressure liquid nitrogen spray cryotherapy in the esophagus. Dis Esophagus. 2010;23(1):13–9.CrossRefGoogle Scholar
  28. 28.
    Shaheen NJ, et al. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc. 2010;71(4):680–5.CrossRefGoogle Scholar
  29. 29.
    Gosain S, et al. Liquid nitrogen spray cryotherapy in Barrett’s esophagus with high-grade dysplasia: long-term results. Gastrointest Endosc. 2013;78(2):260–5.CrossRefGoogle Scholar
  30. 30.
    Canto MI. Carbon dioxide (CO2) cryotherapy is a safe and effective treatment of Barrett’s esophagus (BE) with HGD/Intramucosal carcinoma. Gastrointest Endosc. 2009;69(5):AB341–AB341.CrossRefGoogle Scholar
  31. 31.
    Xue HB, et al. A pilot study of endoscopic spray cryotherapy by pressurized carbon dioxide gas for Barrett’s esophagus. Endoscopy. 2011;43(5):379–85.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.University of Maryland School of MedicineBaltimoreUSA
  2. 2.University of Washington Medical SchoolSeattleUSA

Personalised recommendations