Progression to adenocarcinoma (Barrett’s esophagus to esophageal cancer) is not universal, suggesting that an intensive surveillance program may be sufficient for some patients…
If you’ve been diagnosed with Barrett’s esophagus, with high-grade dysplasia you have several challenges to consider. First and foremost you may be concerned that your BE may develop into esophageal cancer. Secondly, according to the first article linked below, esophagectomy, surgical removal of the BE, can have serious complications. PDT and RFA may be options for your considerations.
I am a cancer survivor and cancer coach. My role is to research evidence-based therapies for people in your situation in order to help you think through the best options for your goals. My perspective is that of a cancer survivor, not an oncologist. I consider both conventional (FDA approved) and evidence-based non-conventional therapies.
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Thank you,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
“The management of patients with Barrett’s esophagus with high-grade dysplasia is controversial. Those who are good operative candidates have traditionally been offered surgical resection because of the high risk that adenocarcinoma is already present or will soon develop [1-4]. On the other hand, progression to adenocarcinoma is not universal, suggesting that an intensive surveillance program may be sufficient for some patients. Furthermore, esophagectomy is associated with significant short- and long-term morbidity and a 3 to 13 percent rate of surgical mortality depending in part upon the surgical expertise and hospital volume…
An alternative approach is based upon the observation that the destruction of intestinal metaplasia using a variety of chemical and thermal methods may be accompanied by regrowth of normal-appearing squamous epithelium, particularly if the patients are treated with proton pump inhibitors to keep them achlorhydric. Of the many endoscopic techniques that are capable of ablating columnar mucosa containing high-grade dysplasia, photodynamic therapy has attracted attention due to its novel approach and early success [5-10]…”
“Photodynamic therapy (PDT) is a drug and device therapy using photosensitizer drugs activated by laser light for mucosal ablation. Porfimer sodium PDT has been used extensively with proven long-term efficacy and durability for the ablation of Barrett esophagus and high-grade dysplasia. and early esophageal adenocarcinoma.
However, continued use is hampered by an associated stricture risk and prolonged photosensitivity (4-6 weeks). Promising single-center European studies using other forms of PDT, such as aminolevulinic acid PDT, have not been replicated elsewhere, limiting the widespread use of other forms of PDT. Future use of PDT in esophageal disease depends on the development of improved dosimetry and patient selection to optimize treatment outcomes while minimizing adverse events and complications.”
