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Endoscopic Treatments: Photodynamic Therapy

  • Raffaele Manta
  • Dolores Sgambato
  • Nico Pagano
  • Giuseppe Galloro
Chapter

Abstract

Barrett’s esophagus (BE) is a premalignant condition where the normal squamous lining is replaced by specialized columnar mucosa. Esophagectomy was the standard treatment for Barrett’s patients with high-grade dysplasia or early cancer but it is associated with major complications and a mortality rate of 3–5% at high-volume centers and up to 20% at low-volume centers. Photodynamic therapy (PDT) offers an alternative outpatient endoscopic procedure eliminating dysplasia and superficial cancer and reducing the risks of complications compared to esophagectomy. It acts through a non-thermal mechanism utilizing the activation of an administrated photosensitizer with a specific wavelength of light. PDT may be used in the tissues accessible to light exposure, such as skin, retina, bronchial tree, and the gastrointestinal tract.

This chapter will provide the technique and guidelines for the application of PDT for management of BE with HGD. Special emphasis will be made by providing information on the technique that has been approved by the FDA. Throughout the chapter, we will provide comparisons between the FDA-approved technique and the relevant data published during phases of the development. Finally, the last ESGE Position Statements by ESGE have been also reported to clarify the current state of the art of PDT in BE.

Keywords

Barrett esophagus Esophageal neoplasms Dihematoporphyrin ether Aminolevulinic acid Ablation therapy 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Raffaele Manta
    • 1
  • Dolores Sgambato
    • 1
  • Nico Pagano
    • 2
  • Giuseppe Galloro
    • 3
  1. 1.Gastroenterology and Digestive Endoscopy UnitNOCSAE Hospital of ModenaModenaItaly
  2. 2.Gastroenterology and Digestive Endoscopy Unit, Department of Medical and Surgical Sciences (DIMEC)University Alma Mater Bologna, Italy—School of MedicineBolognaItaly
  3. 3.Surgical Digestive Endoscopy Unit, Department of Clinical Medicine and SurgeryUniversity of Naples Federico II—School of MedicineNaplesItaly

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