A New Long-Range Through-the-Scope Balloon Applicator for Photodynamic Therapy in the Esophagus and Cardia

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Abstract
The use of photodynamic therapy (PDT) to achieve selective sensitization of precancerous or malignant lesions in the gastrointestinal tract provides an attractive method of achieving endoscopically controlled light-induced tissue destruction [ 1 ] [ 2 ]. For methodological reasons, and particularly in view of the existing well-developed therapeutic alternatives available for palliative treatment of stenosing tumors in the gastrointestinal tract [ 3 ] [ 4 ] [ 5 ], the emphasis in PDT will in the future be placed on the destruction of early carcinoma of the digestive tract confined to the mucosa and to premalignant alterations, particularly in the esophagus. Light diffusers with cylindrical irradiation characteristics have been developed, and have been applied clinically in the treatment of the esophagus - which, being a cylindrical hollow organ, requires homogeneous axial and circumferential illumination [ 6 ] [ 7 ] [ 8 ] [ 9 ] [ 10 ] [ 11 ] [ 12 ] [ 13 ]. However, disadvantages with these applicator systems are that they cannot be inserted through the instrumentation channel of the endoscope, or they cannot be centrally aligned within the lumen of the esophagus, or they allow delivery of light only over a limited distance and thus require segmental light application - for example, in longer Barrett segments. The requirements of clinically reliable light application and adequate monitoring of the interactions between light and photosensitized tissue play an important role, particularly in the treatment of small, superficial lesions. The present report describes the development and clinical application of a flexible balloon applicator up to 10 cm in length, which can be delivered through the endoscope and allows photodynamic ablation of dysplastic Barrett's mucosa in the region of the cardia and esophagus.

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