Circumfrential Ablation of Barrett Esophagus with Persistent High-Grade Dysplasia Following Photodynamic Therapy with Halo 360

Abstract

Purpose: Photodynamic therapy (PDT) is an FDA approved treatment for Barrett esophagus (BE) with high-grade dysplasia (HGD). It is unknown whether patients with persistent HGD following treatment with PDT could benefit from another ablative technique.We report initial safety and efficacy of the HALO360 bipolar balloon electrode in treatment of patients with BE and persistent HGD after treatment with PDT. Methods: Patients previously treated with PDT with persistent HGD confirmed by two pathologists and refusing repeat PDT or surgery were treated with the HALO360 bipolar balloon electrode. Patients underwent repeat treatment at 3 month intervals until all Barrett's epithelium was ablated. Lugol's chromoendoscopy with targeted biopsies from endoscopically visible Barrett and random biopsies from the ablated segment of original Barrett were obtained at regular follow-up interval to assess for dysplasia and residual Barrett epithelium. Endoscopic mucosal resection (EMR) was utilized for nodular HGD or early stage adenocarcinoma (ACA). Adverse events with the procedure were recorded. Results: Five patients with residual HGD after treatment with PDT have been treated with HALO360 bipolar balloon electrode. Two patients had complete ablation of HGD, 3 were found to have residual areas of focal nodular HGD/early stage ACA on follow-up and were treated with EMR. Two out of three had complete resection of ACA with EMR. One patient had involvement of the deep margin of the EMR with ACA and opted to undergo repeat PDT. All 3 patients were cancer/dysplasia free at the last follow-up. No adverse events were recorded. Conclusions: Ablation of BE with persistent HGD or early stage esophageal ACA following treatment with PDT is effective using HALO360 balloon electrode and EMR for nodular disease. Patient tolerance and safety with the procedure has been excellent. Long term follow-up is needed to establish the efficacy of this treatment.