Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7106
Revised: July 21, 2013
Accepted: August 17, 2013
Published online: November 7, 2013
AIM: To compare effectiveness, safety, and cost of photodynamic therapy (PDT) and radiofrequency ablation (RFA) in treatment of Barrett’s dysplasia (BD).
METHODS: Consecutive case series of patients undergoing either PDT or RFA treatment at single center by a single investigator were compared. Thirty-three patients with high-grade dysplasia (HGD) had treatment with porfimer sodium photosensitzer and 630 nm laser (130 J/cm), with maximum of 3 treatment sessions. Fifty-three patients with BD (47 with low-grade dysplasia -LGD, 6 with HGD) had step-wise circumferential and focal ablation using the HALO system with maximum of 4 treatment sessions. Both groups received proton pump inhibitors twice daily. Endoscopic biopsies were acquired at 2 and 12 mo after enrollment, with 4-quadrant biopsies every 1 cm of the original BE extent. A complete histological resolution response of BD (CR-D) was defined as all biopsies at the last endoscopy session negative for BD. Fisher’s exact test was used to assess differences between the two study groups for primary outcomes. For all outcomes, a two-sided P value of less than 0.05 was considered to indicate statistical significance.
RESULTS: Thirty (91%) PDT patients and 39 (74%) RFA were men (P = 0.05). The mean age was 70.7 ± 12.2 and 65.4 ± 12.7 (P = 0.10) year and mean length of BE was 5.4 ± 3.2 cm and 5.7 ± 3.2 cm (P = 0.53) for PDT and RFA patients, respectively. The CR-D was (18/33) 54.5% with PDT vs (47/53) 88.7% with RFA (P = 0.001). One patient with PDT had an esophageal perforation and was managed with non-surgical measures and no perforation was seen with RFA. PDT was five times more costly than RFA at our institution. The two groups were not randomized and had different BD grading are the limitations of the study.
CONCLUSION: In our experience, RFA had higher rate of CR-D without any serious adverse events and was less costly than PDT for endoscopic treatment of BD.
Core tip: Barrett’s esophagus containing dysplasia confers an elevated risk for developing esophageal adenocarcinoma. Photodynamic therapy (PDT) and radiofrequency ablation (RFA) have both been shown in randomized controlled trials to eradicate Barrett’s dysplasia (BD) and reduce the risk for disease progression. We compared the effectiveness, safety, and cost of PDT and RFA in managing BD in consecutive case series performed at single center by single endoscopist. We found that RFA had significantly higher rate of complete histological resolution of Barrett’s dysplasia and it was five times less costly than PDT at our institute compared to PDT.