Patient predictors of esophageal stricture development after photodynamic therapy.

Abstract

BACKGROUND & AIMS:

The most common significant adverse event after photodynamic therapy (PDT) with porfimer sodium is esophageal stricture formation. This study assessed whether pretreatment variables, including prior endoscopic therapy for Barrett's esophagus, are associated with post-PDT stricturing.

METHODS:

Data from all patients who had undergone PDT with porfimer sodium for Barrett's esophagus with high-grade dysplasia, intramucosal carcinoma, or T1 cancer at our institution since 1997 were reviewed.

RESULTS:

One hundred sixteen patients underwent 160 courses of PDT. The incidence of stricture formation after index PDT was 16% (19/116). For all PDT courses, the overall incidence of stricture was 23% (37/160). Stricture rate was significantly higher after a second PDT course compared with index PDT (43% vs 16%, P = .0007). There was no association between post-PDT stricture development and age, gender, body mass index, or prior endoscopic mucosal resection. Patients who developed a stricture had a longer length of Barrett's esophagus before treatment than those who did not develop a stricture (7.7 vs 5.7 cm for index PDT only, P = .025; 7.4 vs 5.7 cm for all PDT courses, P = .007). Length of Barrett's esophagus, multiple PDT courses, and presence of intramucosal carcinoma on pretreatment pathology were independent predictors of post-PDT stricture in a stepwise logistic regression analysis controlling for treatment variables, including treatment length.

CONCLUSIONS:

An increased risk of stricture development was seen after multiple courses of PDT. An association between post-PDT stricture and length of Barrett's esophagus but not treatment length was also found. Endoscopic mucosal resection did not appear to influence the likelihood of stricture development after porfimer sodium-based PDT.

• Authors: Patrick Yachimski, William P Puricelli, Norman S Nishioka
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 6 Issue 3 Pg. 302-8 (Mar 2008) ISSN: 1542-7714 [Electronic] United States
• PMID: 18255349 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Photosensitizing Agents
• Dihematoporphyrin Ether

Topics

• Aged
• Barrett Esophagus (pathology, therapy)
• Dihematoporphyrin Ether (adverse effects, therapeutic use)
• Esophageal Neoplasms (pathology, therapy)
• Esophageal Stenosis (diagnosis, epidemiology, etiology)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Neoplasm Staging
• Odds Ratio
• Photosensitizing Agents (adverse effects, therapeutic use)
• Phototherapy (adverse effects)
• Prognosis
• Retrospective Studies