Cyclooxygenase-2 expression in esophageal epithelium before and after photodynamic therapy for Barrett’s esophagus with high-grade dysplasia or intramucosal carcinoma

Cyclooxygenase-2 expression is upregulated in Barrett’s esophagus and esophageal adenocarcinoma. Photodynamic therapy using porfimer sodium can result in ablation of dysplasia and intramucosal carcinoma, eradication of Barrett’s esophagus, and restitution of squamous epithelium. The aim of this study was to determine the effect of photodynamic therapy on cyclooxygenase-2 expression in esophageal epithelium. Paired pre- and post-photodynamic therapy biopsy samples from the same anatomical levels of 20 individuals who had undergone photodynamic therapy for Barrett’s esophagus with high-grade dysplasia and/or intramucosal carcinoma were immunostained using a cyclooxygenase-2 monoclonal antibody. Cyclooxygenase-2 expression was graded in squamous epithelium, Barrett’s esophagus, and neoplasia (if present) as follows: grade 0 (no staining), grade 1 (staining in 1–10% of cells), grade 2 (staining in 11–90% of cells), and grade 3 (staining in >90% of cells). Pre-photodynamic therapy median cyclooxygenase-2 expression was grade 2 (range 1–3) in neoplastic foci and grade 1 (range 1–3) in nondysplastic Barrett’s esophagus ( P = 0.0009 for pairwise comparison). With the exception of a few cells staining in the basal epithelial layers, median cyclooxygenase-2 expression was graded as 0 (similar to controls) in both pre-photodynamic therapy squamous epithelium and post-photodynamic therapy neosquamous epithelium. This was significantly lower when compared to either neoplastic foci ( P