cqvip:Photodynamic therapy (PDT) may be used to ablate high-grade dysplasia/early stage cancer (HGD/T1) in patients with Barrett’s esophagus. PDT may result in esophageal stricture. This nonrandomized, unblinded, dose deescalation study in consecutive patients was designed to determine the lowest light dose effective for ablation of HGD/T1 while reducing the incidence of stricture. A total of 113 patients received an injection of porfimer sodium (2 mg/kg). Three days later, 630 nm light was delivered by using a 20-mm-diameter PDT balloon at doses of 115 J/cm (n = 59), 105 J/cm (n = 18), 95 J/cm (n = 17), or 85 J/cm (n = 19). Treatment efficacy was determined by obtaining biopsy specimens of the treated area 3 months later. The incidence of stricture was determined by the need for esophageal dilation to treat dysphagia. A stricture was considered severe if 6 or more dilations were required. The incidence of severe stricture was related to the light dose. At 115 J/cm, 15.3%of patients developed severe strictures compared with 5.3%to 5.6%of those treated with the lower doses. At a light dose of 115 J/cm, 17.0%of patients had residual HGD/T1. Light doses of 105 J/cm, 95 J/cm, and 85 J/cm resulted in residual HGD/T1 in 33.3%, 29.4%, and 31.6%of patients, respectively. None of the observations were statistically significant. Decreasing the light dose below 115 J/cm appeared to result in a reduced incidence rate of severe stricture but higher relative frequencies of residual HGD/T1 in Barrett’s esophagus.
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