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ENDOSCOPIC MANAGEMENT OF GASTROESOPHAGEAL JUNCTION ADENOCARCINOMA: COMBINATION OF ENDOSCOPIC MUCOSAL RESECTION AND PHOTODYNAMIC THERAPY
A Morse1, P Blakely2, C Wong3
1University of Alberta, Division of Gastroenterology; 2Royal Alexandra Hospital, Endoscopy Department; 3University of Alberta, Division of Gastroenterology and Royal Alexandra Hospital, Division of Gastroenterology, Edmonton, Alberta
Aims: Esophageal adenocarcinoma and gastroesophageal malignancies have increasing incidence is in the Western World. The approach to management of high grade dysplasia and intramucosal neoplasias is evolving rapidly. This is largely due to the development of endoscopic therapies like endoscopic mucosal resesection (EMR) and muscosal ablative therapies such as photodynamic therapy (PDT). Combining endoscopic and ablative therapy represents a new frontier for management in mucosal limited esophageal adenocarcinomas. There is little in the literature regarding the use of endoscopic therapy for gastroesophageal junction mucosal limited tumors.
Methods: This case series will review the management of three patients at the Royal Alexandra Hospital (Edmonton, Alberta) with T1 gastroesophageal junction adenocarcinomas with a combination of EMR and PDT. Two of these patients had EMR alone with recurrence of adenocarcinoma found within 6-12 months. In all patients, patients were staged with endoscopic ultrasound and CT. EMR was performed using the band and snare and snare techniques. PDT was performed within 4 weeks of EMR in two cases, and immediately following EMR in one case. After injection of porfimer sodium, laser light set at 630nm through a bare diffusing fibre was applied to the affected mucosa at the gastroesophageal junction. Followup endoscopies with biopsies were performed.
Results: The patients in this series had successful treatment with EMR followed by PDT of gastroesophageal junction adenocarcinomas. Follow-up surveillance, up to 26 weeks, showed no recurrence of cancer. There were no endoscopic or medical complications from the procedures.
Conclusions: These patient outcomes suggest that a combination of EMR and PDT may be an effective method of treating mucosally limited GE junction tumors. However, long-term and prospective data is needed.