Squamous Overgrowth Is Not a Safety Concern for Photodynamic Therapy for Barrett's Esophagus With High-Grade Dysplasia
Squamous Overgrowth Is Not a Safety Concern for Photodynamic Therapy for Barrett's Esophagus With High-Grade Dysplasia
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DOI：
10.1053/j.gastro.2008.10.012
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发表时间：
2009-01-01
期刊：
影响因子：
29.4
通讯作者：
Depot, Michelle
中科院分区：
文献类型：
--
作者：
Bronner, Mary P.;Overholt, Bergen F.;Depot, Michelle
背景和目标：使用porfimer钠联合抑酸的光动力疗法（PHOPDT）治疗Barretes食管（BE）伴高度异型增生（HGD）患者。进行了一项为期5年的III期试验，以确定PHOPDT后BE伴HGD的鳞状过度生长的程度。研究方法：在HGD BE患者中比较鳞状过度生长，这些患者被随机分配（2：1）接受PHOPDT（n = 138）或20 mg奥美拉唑每日两次（n = 70）。患者在BE的整个治疗前长度中每隔2 cm接受4象限大型食管活检，直到连续4个季度的随访结果为HGD阴性，然后每两年一次，直至5年或治疗失败。由设盲的胃肠病病理学家审查内镜检查。结果如下：对33,658例活检组织进行的组织学评估显示，当比较每例患者（30% vs 33%）或每例活检组织（0.5% vs 1.3%）时，或当比较每例患者（0.48 vs 0.66）的鳞状细胞过度生长的平均活检组织数量时，两组之间的鳞状细胞过度生长无显著差异（P> 0.05）。在任何患者中，内镜检查的最高级别瘤形成都不是仅在鳞状粘膜下发现的。结论：PHOPDT联合奥美拉唑治疗组与单用奥美拉唑治疗组相比，鳞状细胞过度生长无差异。鳞状细胞过度生长并不能掩盖最晚期的肿瘤形成。在任何病人。在BE患者中使用PHOPDT治疗HGD并不存在无法检测鳞状下异型增生或癌的长期风险。
Background & Aims: Photodynamic therapy with porfimer sodium combined with acid suppression (PHOPDT) is used to treat patients with Barretes esophagus (BE) with high-grade dysplasia (HGD). A 5-year phase 3 trial was conducted to determine the extent of squamous overgrowth of BE with HGD after PHOPDT. Methods: Squamous overgrowth was compared in patients with BE with HGD randomly assigned (2:1) to receive PHOPDT (n = 138) or 20 mg omeprazole twice daily (n = 70). Patients underwent 4-quadrant jumbo esophageal biopsies every 2 cm throughout the pretreatment length of BE until 4 consecutive quarterly follow-up results were negative for HGD and then biannually up to 5 years or treatment failure. Endoscopies were reviewed by blinded gastroenterology pathologists. Results: Histologic assessment of 33,658 biopsies showed no significant difference (P > .05) in squamous overgrowth between groups when compared per patient (30% vs 33%) or per biopsy (0.5% vs 1.3%), or when the average number of biopsies with squamous overgrowth were compared per patient (0.48 vs 0.66). The highest grade of neoplasia per endoscopy was not found exclusively beneath squamous mucosa in any patient. Conclusions: No difference was observed in squamous overgrowth between patients given PHOPDT plus omeprazole compared with only omeprazole. Squamous overgrowth did not obscure the most advanced neoplasia. in any patient. Treatment of HGD with PHOPDT in patients with BE does not present a long-term risk of failure to detect subsquamous dysplasia or carcinoma.