Current status of gastroesophageal photodynamic therapy

Photodynamic therapy (PDT) combines the use of drug and light to produce localized tissue destruction. This review describes the current status of PDT in the treatment of upper gastrointestinal disease. PDT using porfimer sodium (Photofrin) has been approved for use in esophageal adenocarcinoma and squamous cell carcinoma patients in the USA since 1995. Studies have documented both the effectiveness of PDT in palliation of late stage esophageal cancer and in the treatment of patients with locally recurrent neoplasm after chemo-radiation, PDT also has been successfully used to completely obliterate early esophageal cancers without the need for surgery. PDT is the most extensively studied endoscopic ablation technique for the treatment of patients with dysplastic Barrett's esophagus, the precursor of esophageal adenocarcinoma. While early results are encouraging, the optimal depth of injury to ablate Barrett's epithelium has not been determined. Important technological innovations are being developed to more precisely control the level of PDT induced injury.