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High-Energy Laser Therapy of Barrett’s Esophagus: Preliminary Results

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Abstract.

We present the preliminary results obtained by our research group utilizing Nd:YAG and diode lasers to treat Barrett’s esophagus (BE). A total of 15 patients with BE (mean age 58 years) underwent endoscopic laser therapy: 11 with intestinal metaplasia, 2 with low-grade dysplasia, and 2 with high-grade dysplasia. The mean length of BE was 4 cm (range 1–12 cm). Six of these patients also underwent antireflux surgery, and nine were prescribed acid-suppressive medication. Endoscopic Nd:YAG laser treatment was carried out from 1997 to 1999; thereafter, diode laser was employed. The mean follow-up of these patients after the first laser session was 28 months. Patients underwent a mean of 6.5 laser sessions (range 3–17 sessions), with no apparent complications. The mean energy per session was 1705 JJ. Only six of these patients (40%) showed complete endoscopic and histologic remission, but a mean of 77% (SD 23.8%) of the total metaplastic tissue in all these patients was ablated. The percentage of healed mucosa was higher in patients with short-segment BE (92%) (p < 0.05) and in subjects treated by two or more laser sessions per centimeter of BE length (89%) (p < 0.05). All four patients with dysplasia showed histologic regression to nondysplastic BE or to squamous epithelium, without recurrence during a mean follow-up of 30 months. The patients who underwent antireflux surgery and those prescribed pharmacologic treatment had similar results. Nd:YAG and diode laser treatment of BE is a safe, effective procedure; it required two sessions per centimeter of metaplasia; and it achieved complete regression of the dysplasia. Further studies are necessary to quantify its effect on cancer incidence.

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References

  1. A Paull JS Trier MD Dalton et al. (1976) ArticleTitleThe histologic spectrum of Barrett’s esophagus N. Engl. J. Med. 295 476–480 Occurrence Handle1:STN:280:CSmB2c3otVM%3D Occurrence Handle940579

    CAS  PubMed  Google Scholar 

  2. AJ Cameron BJ Ott WS Payne (1985) ArticleTitleThe incidence of adenocarcinoma in columnar-lined (Barrett’s) esophagus N. Engl. J. Med. 313 857–859 Occurrence Handle1:STN:280:BiqB1MnhsFY%3D Occurrence Handle4033716

    CAS  PubMed  Google Scholar 

  3. C Winters SuffixJr TJ Spurling SJ Chobanian et al. (1987) ArticleTitleBarrett’s esophagus: a prevalent occult complication of gastroesophageal reflux disease Gastroenterology 92 118–124 Occurrence Handle3781178

    PubMed  Google Scholar 

  4. O Pech L Gossner A May et al. (2001) ArticleTitleManagement of Barrett’s oesophagus dysplasia and early adenocarcinoma Best Pract. Res. Clin. Gastroenterol. 15 267–284 Occurrence Handle10.1053/bega.2001.0173 Occurrence Handle1:STN:280:DC%2BD3M3mtlOqug%3D%3D Occurrence Handle11355915

    Article  CAS  PubMed  Google Scholar 

  5. DJ Drewitz RE Sampliner HS Garewal (1997) ArticleTitleThe incidence of adenocarcinoma in Barrett’s esophagus: a prospective study of 170 patients followed 4.8 years Am. J. Gastroenterol. 92 212–215 Occurrence Handle1:STN:280:ByiC1M3mtVU%3D

    CAS  Google Scholar 

  6. J Van den Boogert R Hillegersberg Particlevan PD Siersema et al. (1999) ArticleTitleEndoscopic ablation therapy for Barrett’s esophagus with high-grade dysplasia: a review Am. J. Gastroenterol. 94 1153–1160 Occurrence Handle10.1016/S0002-9270(99)00114-8 Occurrence Handle1:STN:280:DyaK1M3kvFaltw%3D%3D Occurrence Handle10235186

    Article  CAS  PubMed  Google Scholar 

  7. DS Levine RC Haggitt S Irvine (1996) ArticleTitleNatural history of high-grade dysplasia in Barrett’s esophagus Gastroenterology 110 A550

    Google Scholar 

  8. R Sampliner (1994) ArticleTitleEffect of up to 3 years to high dose lansoprazole on Barrett’s esophagus Am. J. Gastroenterol. 89 1844–1848 Occurrence Handle1:STN:280:ByqD38bhvFY%3D Occurrence Handle7942680

    CAS  PubMed  Google Scholar 

  9. C Neumann T Iqbal B Cooper (1995) ArticleTitleLong term continuous omeprazole treatment of patients with Barrett’s esophagus Aliment. Pharmacol. Ther. 9 451–454 Occurrence Handle1:CAS:528:DyaK2MXkvV2ju7Y%3D Occurrence Handle8527623

    CAS  PubMed  Google Scholar 

  10. P Sharma RE Sampliner E Carmago (1997) ArticleTitleNormalization of esophageal pH with high dose proton pump inhibitor does not result in regression of Barrett’s esophagus Am. J. Gastroenterol. 92 582–585 Occurrence Handle1:CAS:528:DyaK2sXjtFOisLo%3D Occurrence Handle9128303

    CAS  PubMed  Google Scholar 

  11. KN Lim PJ Waring R Saidi (1999) ArticleTitleTherapeutic options in patients with Barrett’s esophagus Dig. Dis. 17 145–152 Occurrence Handle10.1159/000016919 Occurrence Handle1:STN:280:DC%2BD3c7mt1Oksw%3D%3D Occurrence Handle10697663

    Article  CAS  PubMed  Google Scholar 

  12. A Ortiz LF Martinez de Haro P Parrilla et al. (1996) ArticleTitleConservative treatment versus antireflux surgery in Barrett’s oesophagus: long term results of a prospective study Br. J. Surg. 83 274–278 Occurrence Handle10.1046/j.1365-2168.1996.02129.x Occurrence Handle1:STN:280:BymB2cnpvFQ%3D Occurrence Handle8689188

    Article  CAS  PubMed  Google Scholar 

  13. CP Barham RL Jones LR Biddlestone et al. (1997) ArticleTitlePhototermal laser ablation of Barrett’s oesophagus: endoscopic and histological evidence of squamous re-epithelialisation Gut 41 281–284 Occurrence Handle1:STN:280:DyaK1c%2Fit1ehsQ%3D%3D

    CAS  Google Scholar 

  14. JL Laethem ParticleVan M Cremer MO Peny et al. (1998) ArticleTitleEradication of Barrett’s mucosa with argon plasma coagulation and acid suppression: immediate and mild term results Gut 43 747–751 Occurrence Handle1:STN:280:DyaK1M%2FntFaksQ%3D%3D

    CAS  Google Scholar 

  15. JL Laethem ParticleVan MO Peny I Salmon et al. (2000) ArticleTitleIntramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett’s oesophagus Gut 46 574–577 Occurrence Handle10716690

    PubMed  Google Scholar 

  16. BC Wilson PJ Muller JC Yanch (1986) ArticleTitleInstrumentation and light dosimetry for intra-operative photodynamic therapy (PDT) of malignant brain tumours Phys. Med. Biol. 31 125–133 Occurrence Handle10.1088/0031-9155/31/2/002 Occurrence Handle1:STN:280:BimC2sjpvVc%3D Occurrence Handle3008201

    Article  CAS  PubMed  Google Scholar 

  17. LI Grossweiner JH Hill RV Lobraico (1987) ArticleTitlePhotodynamic therapy of head and neck squamous cell carcinoma: optical dosimetry and clinical trial Photochem. Photobiol. 46 911–917 Occurrence Handle1:STN:280:BieC2Mfjt1A%3D Occurrence Handle3327063

    CAS  PubMed  Google Scholar 

  18. WM Star JPA Marijnissen MJC Gemert Particlevan (1988) ArticleTitleLight dosimetry in optical phantoms and in tissues. I. Multiple flux and transport theory Phys. Med. Biol. 33 437–454 Occurrence Handle10.1088/0031-9155/33/4/004 Occurrence Handle1:STN:280:BieB2cfivVc%3D Occurrence Handle3380885

    Article  CAS  PubMed  Google Scholar 

  19. KK Wang RE Sampliner (2001) ArticleTitleMucosal ablation therapy of Barrett esophagus Mayo Clin. Proc. 76 433–437 Occurrence Handle1:STN:280:DC%2BD3M3ivV2qsw%3D%3D Occurrence Handle11322361

    CAS  PubMed  Google Scholar 

  20. KE Grund D Storek G Farin (1994) ArticleTitleEndoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy Endosc. Surg. Allied Technol. 2 42–46 Occurrence Handle1:STN:280:ByuA28zktlM%3D Occurrence Handle8081915

    CAS  PubMed  Google Scholar 

  21. D Storek KE Grund G Gronbach et al. (1993) ArticleTitleEndoscopic argon gas coagulation: initial clinical experiences Z. Gastroenterol. 31 675–679 Occurrence Handle1:STN:280:ByuC38%2FnvVU%3D Occurrence Handle8291281

    CAS  PubMed  Google Scholar 

  22. W Luman AM Lessels KR Palmer (1996) ArticleTitleFailure of Nd-YAG photocoagulation therapy treatment for Barrett’s oesophagus: a pilot study Eur. J. Gastroenterol. Hepatol. 8 627–630 Occurrence Handle1:STN:280:ByiD3crpsFc%3D Occurrence Handle8853248

    CAS  PubMed  Google Scholar 

  23. JA Salo JT Salminen TA Kiviluoto et al. (1998) ArticleTitleTreatment of Barrett’s esophagus by endoscopic laser ablation and antireflux surgery Ann. Surg. 227 40–44 Occurrence Handle10.1097/00000658-199801000-00006 Occurrence Handle1:STN:280:DyaK1c7gsFymsQ%3D%3D Occurrence Handle9445108

    Article  CAS  PubMed  Google Scholar 

  24. L Bonavina C Ceriani A Carazzone et al. (1999) ArticleTitleEndoscopic laser ablation of nondysplastic Barrett’s epithelium: is it worthwhile? J. Gastrointest. Surg. 3 194–199 Occurrence Handle10.1016/S1091-255X(99)80033-X Occurrence Handle1:STN:280:DyaK1MzovVajsA%3D%3D Occurrence Handle10457346

    Article  CAS  PubMed  Google Scholar 

  25. AP Weston P Sharma (2002) ArticleTitleNeodymium:yttrium-aluminum garnet contact laser ablation of Barrett’s high grade dysplasia and early adenocarcinoma Am. J. Gastroenterol. 97 2998–3006 Occurrence Handle10.1016/S0002-9270(02)05534-X Occurrence Handle12492182

    Article  PubMed  Google Scholar 

  26. S Contini GF Consigli F Lecce ParticleDi et al. (1991) ArticleTitleVital staining of oesophagus in patients with head and neck cancer: still a worthwhile procedure Ital. J. Gastroenterol. 23 5–8 Occurrence Handle1:STN:280:By2D1czgtVE%3D Occurrence Handle1720988

    CAS  PubMed  Google Scholar 

  27. SJ Chobanian EL Cattau SuffixJr C Winters SuffixJr et al. (1987) ArticleTitleIn vivo staining with toluidine blue as an adjunct to the endoscopic detection of Barrett’s esophagus Gastrointest. Endosc. 33 99–101 Occurrence Handle1:STN:280:BiiC1M7nt1Q%3D

    CAS  Google Scholar 

  28. JP Byrne GR Armstrong SEA Attwood (1998) ArticleTitleRestoration of the normal squamous lining in Barrett’s esophagus by argon beam plasma coagulation Am. J. Gastroenterol. 93 1810–1815 Occurrence Handle1:STN:280:DyaK1cvktlSgtg%3D%3D

    CAS  Google Scholar 

  29. M Kahaleh JL Laethem ParticleVan N Nagy et al. (2002) ArticleTitleLong term follow-up and factors predictive of recurrence in Barrett’s esophagus treated by argon plasma coagulation Endoscopy 34 950–955 Occurrence Handle10.1055/s-2002-35847 Occurrence Handle1:STN:280:DC%2BD38jgvV2nsg%3D%3D Occurrence Handle12471537

    Article  CAS  PubMed  Google Scholar 

  30. M Morino F Rebecchi C Giaccone et al. (2003) ArticleTitleEndoscopic ablation of Barrett’s esophagus using argon plasma coagulation (APC) following surgical laparoscopic fundoplication Surg. Endosc. 17 539–542 Occurrence Handle10.1007/s00464-002-9119-9 Occurrence Handle1:STN:280:DC%2BD3s7nvFGkug%3D%3D Occurrence Handle12582755

    Article  CAS  PubMed  Google Scholar 

  31. BF Overholt M Panjehpour JM Haydek (1999) ArticleTitlePhotodynamic therapy for Barrett’s esophagus: follow-up in 100 patients Gastrointest. Endosc. 49 1–7 Occurrence Handle1:STN:280:DyaK1M%2Fosl2qsg%3D%3D

    CAS  Google Scholar 

  32. A Sibille R Lambert JC Souquet et al. (1995) ArticleTitleLong term survival after photodynamic therapy for esophageal cancer Gastroenterology 108 337–344

    Google Scholar 

  33. M Panjehpour BF Overholt JM Haydek et al. (2000) ArticleTitleResults of photodynamic therapy for ablation of dysplasia and early cancer in Barrett’s esophagus and effect of oral steroids on stricture formation Am. J. Gastroenterol. 95 2177–2184 Occurrence Handle10.1016/S0002-9270(00)01092-3 Occurrence Handle1:CAS:528:DC%2BD3cXntFCmsbc%3D Occurrence Handle11007214

    Article  CAS  PubMed  Google Scholar 

  34. HC Wolfsen (2002) ArticleTitlePhotodynamic therapy for mucosal esophageal adenocarcinoma and dysplastic Barrett’s esophagus Dig. Dis. 20 5–17 Occurrence Handle10.1159/000063160 Occurrence Handle12145415

    Article  PubMed  Google Scholar 

  35. F Calzavara L Tomio L Corti et al. (1990) ArticleTitleOesophageal cancer treated by photodynamic therapy alone or followed by radiation therapy J. Photochem. Photobiol. B. 6 167–174 Occurrence Handle10.1016/1011-1344(90)85086-C Occurrence Handle1:STN:280:By6D3sflvFM%3D Occurrence Handle2146377

    Article  CAS  PubMed  Google Scholar 

  36. U Beejay A Ribeiro L Hourigan et al. (2001) ArticleTitlePhotodynamic therapy of high graded dysplasia with intramucosal carcinoma in Barrett’s esophagus: 30 months’ follow-up Gastrointest. Endosc. 53 AB144

    Google Scholar 

  37. KK Wang (1999) ArticleTitleCurrent status of photodynamic therapy of Barrett’s esophagus Gastrointest. Endosc. 49 S20–S23 Occurrence Handle1:STN:280:DyaK1M7lvVOisQ%3D%3D Occurrence Handle10049443

    CAS  PubMed  Google Scholar 

  38. Wang KK, Gutta K, Laukka MA, et al. A prospective randomized trial of low dose photodynamic therapy in the treatment of Barrett’s esophagus [abstract]. In Proceedings of the 5th International Photodynamic Association Biennial Meeting, 1994;123

  39. P Sharma TG Morales RE Sampliner (1998) ArticleTitleShort segment Barrett’s esophagus: the need for standardization of the definition and the endoscopic criteria Am. J. Gastroenterol. 7 103–106

    Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Clinica Chirurgica Generale I, Università di Padova, Via Giustiniani 2, 35128, Padova, Italy

    Lorenzo Norberto M.D., Lino Polese M.D., Imerio Angriman M.D., Francesca Erroi M.D. & Davide F. D’Amico M.D.

  2. Istituto di Anatomia Patologica, Università di Padova, Via Giustiniani 2, 35128, Padova, Italy

    Attilio Cecchetto M.D.

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  1. Lorenzo Norberto M.D.
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  2. Lino Polese M.D.
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Correspondence to Lorenzo Norberto M.D..

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Norberto, L., Polese, L., Angriman, I. et al. High-Energy Laser Therapy of Barrett’s Esophagus: Preliminary Results. World J. Surg. 28, 350–354 (2004). https://doi.org/10.1007/s00268-003-7332-x

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