Photodynamic Therapy versus Radiofrequency Ablation Therapy in Barrettʼs Esophagus with Dysplasia

Abstract

Purpose: Various endoscopic modalities for managing Barrett's dysplasia (BD) are available and no previous comparison of the photodynamic therapy (PDT) vs. radiofrequency ablation therapy (RFT) exists. The aim of this study is to compare these modalities with regard to endoscopic eradication (EE) of Barrett's metaplasia (BM) and BD, adverse events, and costs from a single institution. Methods: Prospectively collected data of consecutive patients were used to identify 88 patients with BM and BD who underwent PDT vs. RFT. All PDT patients had high grade dysplasia (HGD) and either refused surgery or were not considered surgical candidates. Eleven (18%) RFT patients had HGD while others had low grade dysplasia (LGD). Thirty-four patients with BD received PDT and 62 patients with BD underwent RFT with HALO-360 and −90 systems. Combined modalities were performed in 8 patients at different times (PDT prior to RFT in all cases). Results: Thirty-one PDT patients (91%) and 46 (74%) RFT patients were men. The mean age was 70.2±12.2 and 66.2±13; the mean length of BM was 5.7±3.3 cm & 5.4±3.1 cm for PDT and RFT patients, respectively. The EE of BD was (25/34) 73.5% with PDT vs. (55/62) 88.7% with RFT after the completion of first endoscopic ablation treatment (p=0.06). The EE of BM was present in (15/34) 44.1% of PDT vs. (42/62) 67.7% RFT patients, (p=0.03). These EE ratios were improved with subsequent additional ablation therapies. The EE of BD was (60/62) 96.8% with an additional HALO-90 touch-up. Post-PDT clinically significant dysphagia was seen in 9 patients and managed with multiple endoscopic dilatations and in 2 of those cases needed endoscopic temporary stent. Two of post-RFT dysphagia patients were managed by endoscopic dilatation easily and both had also Parkinson's disease. One patient with PDT had esophageal perforation who was managed with non-surgical measures and no perforation was seen in RFT patients. The subsquamous intestinal metaplasia was (4/34) 11.8% with PDT and (2/62) 3.1% with RFT treated patients. According to the calculated cost analysis in our institution, PDT was four times more costly than RFT. Conclusion: Both PDT and RFT can lead to satisfactory eradication of BD and BM. However, RFT management had less adverse events and less costly compared to PDT in patients with BD. Disclosure: Dr Ertan is receiving research grants, lecture & consultant fees from Abbott, Barrx Medical,Centocor, Eisai and UCB.