PDT versus APC in Barrett's Esophagus
Photodynamic Therapy(PDT) versus Argon Plsma Coagulation (APC) in neoplastic and non-Neoplastic Barrett
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The aim of endoscopic ablation in the lower third of the esophagus is to eliminate the intestinal metaplasia and hence the risk of developing adenocarcinoma. Different methods have been advocated but, to date, none of them has been shown to be the standard. We used different methods according to individualized selection criteria. We support the use of PDT for patients with grade-4 IPN. Supplementary methods for the rest of Barrett are of particular value. EMR is suitable for elevated lesion with suspicion of IPN, as it provides considerable material for exact histopathological examination. APC...
The aim of endoscopic ablation in the lower third of the esophagus is to eliminate the intestinal metaplasia and hence the risk of developing adenocarcinoma. Different methods have been advocated but, to date, none of them has been shown to be the standard. We used different methods according to individualized selection criteria. We support the use of PDT for patients with grade-4 IPN. Supplementary methods for the rest of Barrett are of particular value. EMR is suitable for elevated lesion with suspicion of IPN, as it provides considerable material for exact histopathological examination. APC is needed for the elimination of the residual islands of Barrett's epithelium. APC alone could be enough for grade-3 IPN within Barrett's muosa less than 5 cm in length, as it showed esophageal stricture when used for longer lesions. Endoscopic ablation therapy is highly effective in eradicating intraepithelial neoplasia (IPN) within Barrett's esophagus. The success in totally eradicating the metaplastic epithelium was much lower. Long-term follow-up is inevitable to prove the effectiveness of ablation therapy in reducing the incidence of adenocarcinoma of the esophagus.
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