Carpe luz—seize the light: endoprevention of esophageal adenocarcinoma when using photodynamic therapy with porfimer sodium

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This editorial and that of Dr. Siersema 1 Siersema P. Photodynamic therapy for Barrett's esophagus: not yet ready for the premier league of endoscopic interventions. Gastrointest Endosc. 2005; 62: 503-507 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar accompany the publication of the landmark study of Overholt and colleagues who performed an international, multicenter, partly blinded, prospective, randomized controlled trial of porfimer sodium (Photofrin; Axcan Pharma, Mont-Saint-Hilaire, Quebec, Canada) photodynamic therapy (PDT) for the treatment of patients with Barrett's esophagus and high-grade dysplasia. 2 Overholt B.F. Lightdale C.J. Wang K.K. et al. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett's esophagus: international, partially blinded, randomized, phase III trial. Gastrointest Endosc. 2005; 62: 488-498 Abstract Full Text Full Text PDF PubMed Scopus (455) Google Scholar This study provides important information about the natural history of Barrett's high-grade dysplasia, the efficacy and the feasibility of endoscopic mucosal ablation with porfimer sodium PDT and the use of endoscopy to prevent esophageal carcinoma (“endoprevention”), as summarized in Table 1. Table 1Advantages and disadvantages of Ps-PDT for Barrett's esophagus with high-grade dysplasia Advantages Extensive North American clinical experience (multiple, large, single-center studies, including long-term results that feature >5 y follow-up). Barrett's high-grade dysplasia elimination in 77% Subsquamous glandular epithelium (“buried Barrett's”) in 4%-6% Annual cancer incidence 14% (omeprazole alone) 6% (Ps-PDT plus omeprazole) 1%-3% (Ps-PDT plus PPI and complete thermal ablation of residual glands) Cost effective: compared with surveillance endoscopy and esophagectomy Disadvantages Strictures occur in 18%-22% (one course of PDT) to 34% (two courses of PDT) Prolonged photosensitivity lasting 4-6 wk Need for subsequent thermal ablation for residual areas of glandular epithelium in about 50% of patients to prevent metachronous carcinoma Ps-PDT, Porfimer sodium photodynamic therapy; PPI, proton pump inhibitor. Open table in a new tab Ps-PDT, Porfimer sodium photodynamic therapy; PPI, proton pump inhibitor.