Original ArticleEsophageal Dysmotility in Patients Undergoing Photodynamic Therapy
Section snippets
PATIENTS AND METHODS
Twenty-three consecutive patients with esophageal adeno-carcinoma with Barrett esophagus or Barrett esophagus with high-grade dysplasia presenting for PDT were prospectively enrolled in the study between January 1998 and October 1999. Esophageal adenocarcinoma patients were treated with PDT for persistent or recurrent neoplasm after chemoradiation therapy or for newly diagnosed obstructing neoplasms without prior therapy. All adenocarcinoma patients underwent a complete clinical evaluation,
RESULTS
During the study period, 23 patients were referred to our center for PDT; 10 patients had Barrett esophagus with high-grade dysplasia, and 13 patients had adenocarcinoma. There were 20 men and 3 women, and the mean age was 72 years (range, 50–86 years). Manometric findings before and after PDT are summarized in Table 1, Table 2, Table 3 and Figure 1. Overall, 11 patients (48%) had normal motility prior to PDT, including 5 cancer patients (22%) who had previously undergone chemoradiation
DISCUSSION
Photodynamic therapy has been approved for the palliative treatment of dysphagia in patients with obstructing esophageal cancer since 1995. Previously, we had treated patients who suffered persistent dysphagia despite excellent tumor photoablation and recanalization of the esophageal tumor. This observation raised the question of whether esophageal motility abnormalities might explain this persistent dysphagia and whether this dysmotility was related to the underlying disease, previous
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Cited by (28)
Cytostatic and cytotoxic drugs
2010, Side Effects of Drugs AnnualCitation Excerpt :Deterioration of esophageal motility can occur after photodynamic therapy for esophageal carcinoma or Barrett’s esophagus. Of 23 patients, 13 with esophageal carcinoma and 10 with Barrett’s esophagus, 11 had normal motility, 6 had ineffective esophageal motility, and 6 had aperistalsis; 5 of those with aperistalsis had carcinomas (112c). Follow-up tracings after photodynamic therapy showed that 6 had normal motility, 7 had ineffective esophageal motility, and 10 had aperistalsis.
Endoluminal Therapy for Esophageal Disease: An Introduction
2010, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :Endoscopic ablation methods should have a low rate of complication, such as stricture formation, bleeding, perforation, and must be well-tolerated by the patient. The endoluminal techniques that have been developed for removing BE include circumferential balloon-based radio-frequency ablation,27–32 aminolevulinic acid and porfimer sodium photodynamic therapy,33–49 endoscopic mucosal resection and submucosal dissection,50–52 laser ablation,4,53–59 argon plasma coagulation,4,53,60–71 multipolar electrocoagulation,4,53,72–76 and liquid nitrogen and carbon dioxide cryotherapy.77–79 However, these devices probably differ in their method of ablation, including in treatment depth.
Endoluminal Therapy for Barrett's Esophagus
2007, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :In the case of sodium porfimer, after it enters a cell, it is distributed throughout the cytoplasm and becomes tightly bound to mitochondrial membranes, but other subcellular targets include lysosomes, Golgi apparatus, and the rough endoplasmic reticulum [93,94]. The literature summarizing the clinical use of PDT recently has been published elsewhere [48,95–109]. Although several photosensitizing agents have been developed for PDT (such as ALA and m-tetrahydroxyphenyl chlorine, mTHPC) [110,111], only porfimer sodium has received regulatory approval to treat patients who have Barrett's esophagus with high-grade dysplasia in North America [112].
Predictors of stricture formation after photodynamic therapy for high-grade dysplasia in Barrett's esophagus{A figure is presented}
2007, Gastrointestinal EndoscopyCitation Excerpt :However, this is the largest series of patients with HGD treated with PDT reported from the United States. It has been reported that patients with HGD treated with PDT may have underlying esophageal dysmotility, which may contribute to dysphagia.28 This could have influenced the performance of esophageal dilation in patients.
The effect of photodynamic therapy (PDT) on oesophageal motility and acid clearance in patients with Barrett's oesophagus
2006, Journal of Photochemistry and Photobiology B: Biology