Higher Rates of Remission of Esophageal Intestinal Metaplasia Using Photodynamic Therapy Compared to Radiofrequency Ablation

Abstract

Purpose: There are few data comparing the efficacy of porfimer sodium photodynamic therapy (Ps-PDT) and radiofrequency ablation (RFA) in achieving complete remission of intestinal metaplasia (CRIM) or dysplasia (CRD). The aim of this study was to highlight the differences in time to CRIM and time to CRD among patient treated with Ps-PDT compared to RFA. Methods: This was a retrospective, observational study of patients with BE (+/- dysplasia) treated at a tertiary care center with Ps-PDT or RFA. Information of interest was collected regarding baseline characteristics (age, gender, race, history of smoking, histology, previous statin use, previous NSAID use, previous treatments [EMR, PDT, RFA, APC], length of Barrett's segment), and follow-up characteristics (date of follow-up visit, procedures performed, biopsy results, complications). The primary endpoint of this study was the occurrence of the first normal biopsy after starting treatment with either RFA or Ps-PDT (CRIM). We used Kaplan-Meier analysis, Wilcoxon rank sum test and Cox proportional hazards regression models to compare and assess time to CRIM and CRD. Results: A total of 233 patients were included in this study. Of those, 103 patients had RFA while 130 patients had Ps-PDT between August 2001 and June 2012. The median follow-up time after first Ps-PDT or RFA treatment was 14.3 months. Patients who underwent RFA were younger (median age 65 years vs. 71 years, p<0.001) and less likely to have a history of smoking (67% vs. 82%, p=0.017). There was no difference in other variables between both groups. Median time to CRIM was 8.8 months in patients with RFA compared to 2.3 months in patients with Ps-PDT. Patients who were treated with Ps-PDT were more likely to experience a normal biopsy than patients who were treated with RFA (RR: 2.42, P<0.001), and this result remained consistent in multivariable analysis (RR: 2.67, P<0.001). Kaplan-Meier cumulative incidences CRIM are shown in Figure 1 for RFA patients and Ps-PDT patients separately.FigureConclusion: When treating patient with BE +/- dysplasia, the rate of CRIM is higher in patients treated with Ps-PDT compared to RFA, when controlling for patient age, gender, baseline histology, BE length, use of statins and NSAIDs. Head to head studies may be needed to better quantify this difference and its potential implications. Disclosure - Dr. Waseem David - Research fellow: Pinnacle Biologics, Grant/Research Support. This research was supported by an industry grant from Pinnacle Biologics.