Mucosal ablation therapy of barrett esophagus.

Barrett esophagus is defined by the metaplasia of existing squamous mucosa into a specialized intestinal-type mucosa. The importance of this metaplasia is the association of this condition with the development of adenocarcinoma of the esophagus. Elimination of the metaplastic mucosa may decrease the cancer risk. Currently, several forms of therapy have evolved with the goal of replacing the specialized mucosa with normal squamous mucosa. These proposed treatments include photodynamic therapy and thermal techniques. The effectiveness of photodynamic therapy varies depending on the pharmaceutical photosensitizer used and the wavelength of light applied to activate the drug. Thermal techniques include multipolar coagulation, argon plasma coagulation, KTP:YAG laser therapy, Nd:YAG laser therapy, and argon laser therapy. Finally, mucosal resection has been attempted through the endoscope to remove large areas of the Barrett mucosa. All of these ablative strategies attempt to destroy the metaplastic mucosa and promote the regrowth of squamous epithelium. These therapies have demonstrated the ability to "reverse" the metaplasia to varying degrees, but a decrease in cancer risk has not been demonstrated conclusively with any of these treatment methods.

[1]  J. Byrne,et al.  Restoration of the normal squamous lining in Barrett's esophagus by argon beam plasma coagulation. , 1998 .

[2]  L. Gossner,et al.  Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus. , 2000, Gastroenterology.

[3]  C. Schmitt,et al.  Barrett's esophagus: a new look at surveillance based on emerging estimates of cancer risk. , 1999 .

[4]  R. Sampliner,et al.  Reversal of Barrett's esophagus with acid suppression and multipolar electrocoagulation: preliminary results. , 1996, Gastrointestinal endoscopy.

[5]  D. Ahlquist,et al.  Does performance status influence the outcome of Nd:YAG laser therapy of proximal esophageal tumors? , 1994, Gastrointestinal endoscopy.

[6]  J H Peters,et al.  Occult esophageal adenocarcinoma: extent of disease and implications for effective therapy. , 1999, Annals of surgery.

[7]  A. May,et al.  A new long-range through-the-scope balloon applicator for photodynamic therapy in the esophagus and cardia. , 1999, Endoscopy.

[8]  D. Vernon,et al.  Endogenous porphyrin distribution induced by 5-aminolaevulinic acid in the tissue layers of the gastrointestinal tract. , 1993, Journal of photochemistry and photobiology. B, Biology.

[9]  E. G. Hahn,et al.  Photodynamic destruction of high grade dysplasia and early carcinoma of the esophagus after the oral administration of 5‐aminolevulinic acid , 1999, Cancer.

[10]  M. Scheurlen,et al.  Reconstitution of squamous epithelium in Barrett's oesophagus with endoscopic argon plasma coagulation: a prospective study. , 1998, Scandinavian journal of gastroenterology.

[11]  L. Gossner,et al.  Photodynamic ablation of high-grade dysplasia and early cancer in Barrett's esophagus by means of 5-aminolevulinic acid , 1998 .

[12]  M. Sotiropoulou,et al.  Complete regression of Barrett's esophagus with heat probe thermocoagulation: mid-term results. , 1999, Gastrointestinal endoscopy.

[13]  R. Sampliner,et al.  Ablative therapies for the columnar-lined esophagus. , 1997, Gastroenterology clinics of North America.

[14]  R. Sampliner,et al.  Normalization of esophageal pH with high-dose proton pump inhibitor therapy does not result in regression of Barrett's esophagus. , 1997, The American journal of gastroenterology.

[15]  H. Oppelaar,et al.  PARTIAL PROTECTION OF PHOTODYNAMIC‐INDUCED SKIN REACTIONS IN MICE BY N‐ACETYLCYSTEINE: A PRECLINICAL STUDY , 1994, Photochemistry and photobiology.

[16]  R. Sampliner,et al.  Biomarker studies in reversed Barrett's esophagus. , 1999 .

[17]  F. Ramirez,et al.  The efficacy and safety of argon plasma coagulation therapy in Barrett's esophagus. , 1999, Gastrointestinal endoscopy.

[18]  L. Brandt,et al.  Repeat laser therapy of recurrent Barrett's epithelium: success with anacidity. , 1995, Gastrointestinal endoscopy.

[19]  R. Sampliner.  Effect of up to 3 years of high-dose lansoprazole on Barrett's esophagus. , 1994, The American journal of gastroenterology.

[20]  Y. K. Chen,et al.  Successful reversal of Barrett's esophagus with multipolar electrocoagulation despite inadequate acid suppression. , 1999, Gastrointestinal endoscopy.

[21]  Kenneth K Wang,et al.  Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett's esophagus. , 2000, Gastrointestinal endoscopy.

[22]  E. G. Hahn,et al.  KTP laser destruction of dysplasia and early cancer in columnar-lined Barrett's esophagus. , 1999, Gastrointestinal endoscopy.

[23]  J. Ajani,et al.  Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer. , 2000, The Journal of thoracic and cardiovascular surgery.

[24]  W. Samowitz,et al.  Restoration of squamous mucosa after ablation of Barrett's esophageal epithelium. , 1993, Gastroenterology.

[25]  H. Inoue.  Treatment of esophageal and gastric tumors. , 2001, Endoscopy.

[26]  B. Overholt,et al.  Photodynamic therapy for Barrett's esophagus: follow-up in 100 patients. , 1999, Gastrointestinal endoscopy.

[27]  A. Bhattacharyya,et al.  Durability of new squamous epithelium after endoscopic reversal of Barrett's esophagus. , 1999, Gastrointestinal endoscopy.

[28]  J. Blankensteijn,et al.  Adenocarcinoma in Barrett's oesophagus: an overrated risk. , 1989, Gut.

[29]  L. Bonavina.  Early oesophageal cancer: Results of a European multicentre survey , 1995, The British journal of surgery.

[30]  J. Devière,et al.  Eradication of Barrett’s mucosa with argon plasma coagulation and acid suppression: immediate and mid term results , 1998, Gut.

[31]  H. Barr,et al.  Eradication of high-grade dysplasia in columnar-lined (Barrett's) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX , 1996, The Lancet.

[32]  P. Pairolero,et al.  Barrett's esophagus with high-grade dysplasia: an indication for esophagectomy? , 1992, The Annals of thoracic surgery.

[33]  A. Bhattacharyya,et al.  Laser and multipolar electrocoagulation ablation of early Barrett's adenocarcinoma: long-term follow-up. , 1999, Gastrointestinal endoscopy.

[34]  T. Sauerbruch,et al.  Treatment of Barrett's esophagus by endoscopic argon plasma coagulation. , 1997, Endoscopy.

[35]  Kenneth K Wang,et al.  Current status of photodynamic therapy of Barrett's esophagus. , 1999, Gastrointestinal endoscopy.