Recurrence of Esophageal Intestinal Metaplasia and Dysplasia: Porfimer Sodium Photodynamic Therapy versus Radiofrequency Ablation

Abstract

Purpose: Both porfimer sodium photodynamic therapy (Ps-PDT) and radiofrequency ablation (RFA) are effective endoscopic ablation modalities used to eradicate esophageal intestinal metaplasia with or without dysplasia/neoplasia among patients with Barrett's Esophagus (BE). The aim of this study is to compare the time to recurrence of intestinal metaplasia and dysplasia between PDT and RFA among patients with BE. Methods: This was a retrospective, observational study using a large database of patients treated with Ps-PDT and RFA in a tertiary referral center. Information collected included age, gender, race, history of smoking, histology of statin use, NSAID use, previous treatments, length of Barrett's segment, date of follow-up visit, procedures and biopsy results. The primary endpoint of this study was the recurrence of IM among patients who achieved complete remission of IM (CRIM). We used Kaplan-Meier analysis, Wilcoxon rank sum test and Cox proportional hazards regression models to assess and compare time to recurrence of IM and dysplasia between PDT and RFA. 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. 77% (n=180) of patients achieved remission of IM. After a median follow-up time of 14.3 months, the rate of recurrence was similar among patients with RFA compared to PDT (36.4% vs. 48.1%). There was no significant difference in the likelihood of experiencing disease recurrence following normal biopsy between PDT and RFA patients in either single variable analysis (RR: 1.44, P=0.15) or multivariable analysis (RR: 1.26, P=0.42). Kaplan-Meier curves for time to recurrence of intestinal metaplasia/neoplasia for PDT and RFA is shown in Figure 1. In these patients who experienced freedom from dysplasia, the risk of recurrence of dysplasia did not differ significantly between the two treatment groups in single variable analysis (RR: 1.15, P=0.63) or multivariable analysis (RR: 1.09, P=0.78).Fig 1: Kaplan-Meier curves for time to recurrence of intestinal metaplasia/neoplasia.Conclusion: Among patient with BE, there was no significant difference in disease recurrence between patients treated with RFA compared to Ps-PDT when controlling of age, gender, race, BE length, baseline histology, and use of NSAIDs or statins. Disclosure - Dr. Waseem David - Research Fellow: Pinnacle Biologics, Grant/Research Support This research was supported by an industry grant from Pinnacle Biologics