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Bare fiber photodynamic therapy using porfimer sodium for esophageal disease
Herbert Wolfsen1, Marcia Canto1, Bob Etemad1
1Divisions of Gastroenterology and Hepatology, Mayo Clinic, 6A Davis Bldg., 4500 San Pablo Road, Jacksonville, FL 32224, USA; Divisions of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA; Divisions of Gastroenterology and Hepatology, Ochsner Clinic, New Orleans, LA, USA; Divisions of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA; Divisions of Gastroenterology and Hepatology, Duke University, Durham, NC, USA; Divisions of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, WA, USA; Divisions of Gastroenterology and Hepatology, University of California, San Francisco, CA, USA; Divisions of Gastroenterology and Hepatology, University of Miami, Miami, FL, USA; Divisions of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA; Divisions of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA.
Abstract:
During Digestive Disease Week 2005 in Chicago, Illinois, our group of 10 gastrointestinal photodynamic therapists met to discuss variations in procedural technique and treatment protocols. An extensive review of the use of photodynamic therapy (PDT) for esophageal disease has recently been published elsewhere [Wolfsen HC. Present status of photodynamic therapy for high-grade dysplasia in Barrett's esophagus. J Clin Gastroenterol 2005;39(3):189-202]. This report, based mostly on clinical experience and common sense rather than evidence-based medicine, is a detailed discussion of pragmatic issues. In summary, our centers treat patients with Barrett's dysplasia, Barrett's or squamous cell carcinoma using the photosensitizer porfimer sodium (2mg/kg total body weight) and bare fiber PDT (no fiber centering devices). Aggressive suppression of gastric acid is uniformly emphasized. The most common technique variables were the light energy source, light dosimetry and the amount of Barrett's mucosa treated during a course of PDT. Standardization of porfimer sodium PDT procedures and light dosimetry may enhance treatment outcomes.
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