Aminolevulinic acid-induced photodynamic therapy: safe and effective ablation of dysplasia in Barrett’s esophagus

Photodynamic therapy (PDT) is a treatment in which cell damage is achieved by the action of light on a photosensitizer. The aim of this study was to assess the value of PDT in the treatment of Barrett's esophagus with low-grade dysplasia (LGD). Forty patients with dysplastic Barrett's esophagus were given aminolevulinic acid (ALA) 30 mg/kg orally followed 4 h later by laser endoscopy. Follow-up endoscopy and biopsies were performed at 1, 6 and 12 months. A macroscopic response was seen in 33 out of 40 patients, with a median decrease in columnar epithelial area of 30% (range 0-90%). Post-treatment biopsies showed no dysplasia in 39 out of 40 patients, with LGD remaining in one case. This was maintained at 6 and 12 months. There were no significant side-effects. This study demonstrates that ALA-induced PDT provides safe and effective ablation therapy for Barrett's esophagus and is particularly useful against dysplasia.