Aminolaevulinic acid-induced photodynamic therapy in the treatment of dysplastic Barrett's oesophagus and adenocarcinoma

Photodynamic therapy (PDT) may have a role in the prevention of oesophageal cancer. Ten patients with Barrett's oesophagus, three with law-grade dysplasia (LGD), four with high-grade dysplasia (HGD), one with carcinoma in situ and two with invasive carcinoma, were treated with PDT. All received 30 mg/kg aminolaevulinic acid (ALA) followed 4 h later by laser endoscopy. Half were treated with red light (630 nm; 100 mW/cm(2) for 1000 s) and half with green light (514 nm; 100 mW/cm(2) for 500 s). Columnar epithelial regression was seen in all patients with dysplasia (mean area decrease 44%; range 10-100%), with apparent elimination of dysplasia in all cases. In patients with in situ or invasive carcinoma, no response was seen. ALA-induced PDT, using either red or green light, produces effective ablation of dysplastic Barrett's oesophagus, hence may have a role in the prevention of oesophageal carcinoma, but has little effect on in situ or invasive adenocarcinoma.