Porfimer sodium photodynamic therapy for management of Barrett's esophagus with high‐grade dysplasia

Abstract

Porfimer sodium photodynamic therapy (ps-PDT) for Barrett's esophagus is a powerful endoscopic treatment that can eliminate high-grade dysplasia (HGD) and Barrett's mucosa and reduce the risk of development of cancer in these patients. Ps-PDT typically results in destruction of Barrett's esophagus in the majority of the treated area. However, residual small island of Barrett's mucosa may persist after PDT. Therefore, adjuvant thermal ablation should be available during follow-up endoscopies for ablation of residual islands of Barrett's mucosa. PDT should be applied concurrent with effective proton pump inhibitor therapy. This article provides a practical guide for application of porfimer sodium balloon PDT for management of Barrett's esophagus with HGD. Recommendations are provided for patient selection and screening, delivery of PDT to include light dosimetry, methodology for follow-up endoscopies, as well as discussing the potential side effects and complications.

Photodynamic therapy (PDT) using HPPH for the treatment of precancerous lesions associated with barrett's esophagus

“…First, HPPH‐PDT appears to be safe in patients with early esophageal lesions. The AE profile in the two related studies reported here is similar to that of the published randomized clinical trials with porfimer sodium‐PDT 11, 21, with some notable exceptions. The major rationale for the clinical development of HPPH was the much reduced time of general photosensitivity observed in preclinical and clinical studies 18.…”

“…The reported stricture rate after up to three porfimer sodium‐PDT exposures is 36% and 27%, respectively 11, 22, 24, 25. One porfimer sodium‐PDT treatment resulted in a 12% stricture rate 11, 21, comparable to the stricture rate in this study.…”

“…There were no occurrences of bleeding or perforation, and no death were recorded. Panjehpour and Overholt 21 mention a small risk of atrial fibrillation after PDT. In a series of 100 patients with porfimer sodium PDT, 3 patients developed this AE 25.…”

From molecules to nanovectors: Current state of the art and applications of photosensitizers in photodynamic therapy

“…In gastroenterology, PDT benefits from a renewed interest due to the development of diode lasers (which advantageously replace the first dye lasers pumped by argon laser) and to the demonstration of its effectiveness i) for the treatment of superficial esophageal cancers in patients inaccessible to another treatment, with a post-radiotherapy recurrence (Wu et al, 2019), ii) for severe dysplasia in Barrett's mucosa (Panjehpour and Overholt, 2006), and iii)…”

Introduction

“…Further, the onset of cancer in the PDTþOmeprazole arm was half that of the control arm (Omeprazole alone). 1 In addition, using PDT does not preclude the surgery should the HGD return or cancer develop. You would think that given the option of PDT versus esophagectomy most patients would opt for PDT (Photofrin 1 photosensitivity is a non-issue for these patients).…”