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Long Term Outcomes Following Treatment of High Grade Dysplasia in Barretts Esophagus

Comparison of Endoscopic and Surgical Treatment Cohorts

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Prasad, Ganapathy A., M.D.; Wang, Kenneth K., M.D.; WongKeeSong, Michel, M.D.; Buttar, Navtej S., M.D.; Lutzke, Lori, CCRP; Borkenhagen, Lynn, R.N.; Papenfuss, Sarah

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S36
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

Purpose: Photodynamic therapy (PDTP for High Grade Dysplasia (HGD) in Barrett's Esophagus (BE) is an FDA approved alternative to esophagectomy. Critical information for clinical deciision making regarding overall survival of patients followed long-term after these therapies has not been available. Our aim is to determine long term survival of a cohort of patients with HGD treated with PDT compared to patients treated with esophagectomy.

Methods: We reviewed records of patients seen at Mayo Clinic for HGD between 1994 and 2005. Data was abstracted from a prospectively maintained database for those that had PDT. PDT was performed by a single investigator, using 630 nm light administered using a bare cylindrical diffusing fiber or a centering balloon, 48 hours following the intravenous administration of a photosensitizer. Light dosages were between 150–200 J/cm fiber. Drug doses were equivalent to 2 mg/kg of sodium porfimer. Esophagectomy was performed by either transhiatal or trans-thoracic approaches by experienced surgeons. We excluded all patients with evidence of cancer on biopsies. Vital status and death date information was queried using an institutionally approved internet research and location service. Statistical analysis was performed using Kaplan Meier curves and Cox proportional hazards ratios.

Results: 129 patients (65%) were treated by PDT and 71 (35%) were treated by esophagectomy. The mean age of patients undergoing PDT was older than that of patients undergoing surgery (64.6 versus 60.3, p = 0.0076). Gender distribution was comparable (males 87% versus 94%, p = 0.1). There were 17 total deaths. Overall mortality in the PDT group was 9% (11/129), compared with 8.5% (6/71) in the surgery group, over a median follow up of 57.4 months (Interquartile range 3.03, 129.7) in the PDT group and 63.4 months (IQR 34.8, 82.6) in the surgery group. Overall survival was similar between the 2 groups (Wilcoxon test = 0.0924, p = 0.76). On univariate analysis, neither age, nor treatment modality (PDT or surgery) were significant predictors of mortality. Treatment modality was also not a significant predictor of mortality on multivariate analysis, after adjusting for age and gender.

Conclusions: Overall mortality and long-term survival in patients with HGD treated with PDT appears to be comparable to that of patients treated with esophagectomy.

© The American College of Gastroenterology 2005. All Rights Reserved.