Severe coagulopathy is not a contraindication for photodynamic therapy in a patient with Barretts esophageal carcinoma

Kenneth Ke Ning Wang, A. Norbash, A. Geller, M. Wong Kee Song

Research output: Contribution to journalArticle

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Abstract

Photodynamic therapy (PDT) theoretically can be applied in the presence of a coagulopathy because of its ability to cause thrombosis of small vessels and ischemic necrosis. However, this has not been reported to be useful on a clinical basis. AIM: To determine if severe coagulopathy would limit the application of PDT in the treatment of a superficial esophageal carcinoma. METHODS: A 74 year old female patient with HCV related Childs C cirrhosis was referred for treatment of an esophageal cancer associated with Barrett's esophagus. The coagulopathy was manifested by an elevated prothrombin time with INR>2.0 and platelet counts <30,000, Prior endoscopic biopsies had caused gastrointestinal hemorrhage requiring 2 units of blood despite fresh frozen plasma and platelets. This coagulopathy was felt to contraindicate surgical resection. The patient had an endoscopic ultrasound that demonstrated that she had a 10 cm Barrett segment with a 3 cm diameter tumor in the middle of the segment. The tumor was staged as a T2 lesion that on biopsy was a grade 3 adenocarcinoma. Due to the good functional status of the patient, compassionate use of photodynamic therapy was approved by the IRB. The patient was given 5.0 mg/kg of hematoporphyrin derivative IV. Forty-eight hours following injection, photodynamic therapy was performed at a light dose of 200 J/cm fiber using a 1.5 cm length fiber delivering 630 nm light at a power of 400 mW. Treatment was confined to the tumor and proximal Barrett's segment. The patient was not given any coagulation factors. RESULTS: The patient experienced nausea and odynophagia for a period of 2 weeks following the therapy. No clinical evidence of gastrointestinal hemorrhage occurred and the patient recovered completely in a month with ingestion of a normal diet. Follow-up endoscopy three months following treatment revealed an esophageal ulcer, regression of 4 cm of the Barrett's segment, and absence of a mass on EUS. Biopsies of the epithelium did reveal Barrett's epithelium but no evidence of carcinoma. CONCLUSIONS: Photodynamic therapy for esophageal carcinoma can be conducted in the setting of severe coagulopathy and may be a viable treatment for patients who are not candidates for surgery.

Original languageEnglish (US)
Pages (from-to)346
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
StatePublished - 1996

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Photochemotherapy
Carcinoma
Barrett Esophagus
Gastrointestinal Hemorrhage
Biopsy
Therapeutics
Compassionate Use Trials
Hematoporphyrin Derivative
Light
Neoplasms
Blood Coagulation Factors
International Normalized Ratio
Research Ethics Committees
Prothrombin Time
Esophageal Neoplasms
Platelet Count
Nausea
Endoscopy
Ulcer
Adenocarcinoma

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Severe coagulopathy is not a contraindication for photodynamic therapy in a patient with Barretts esophageal carcinoma. / Wang, Kenneth Ke Ning; Norbash, A.; Geller, A.; Song, M. Wong Kee.

In: Gastrointestinal Endoscopy, Vol. 43, No. 4, 1996, p. 346.

Research output: Contribution to journalArticle

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abstract = "Photodynamic therapy (PDT) theoretically can be applied in the presence of a coagulopathy because of its ability to cause thrombosis of small vessels and ischemic necrosis. However, this has not been reported to be useful on a clinical basis. AIM: To determine if severe coagulopathy would limit the application of PDT in the treatment of a superficial esophageal carcinoma. METHODS: A 74 year old female patient with HCV related Childs C cirrhosis was referred for treatment of an esophageal cancer associated with Barrett's esophagus. The coagulopathy was manifested by an elevated prothrombin time with INR>2.0 and platelet counts <30,000, Prior endoscopic biopsies had caused gastrointestinal hemorrhage requiring 2 units of blood despite fresh frozen plasma and platelets. This coagulopathy was felt to contraindicate surgical resection. The patient had an endoscopic ultrasound that demonstrated that she had a 10 cm Barrett segment with a 3 cm diameter tumor in the middle of the segment. The tumor was staged as a T2 lesion that on biopsy was a grade 3 adenocarcinoma. Due to the good functional status of the patient, compassionate use of photodynamic therapy was approved by the IRB. The patient was given 5.0 mg/kg of hematoporphyrin derivative IV. Forty-eight hours following injection, photodynamic therapy was performed at a light dose of 200 J/cm fiber using a 1.5 cm length fiber delivering 630 nm light at a power of 400 mW. Treatment was confined to the tumor and proximal Barrett's segment. The patient was not given any coagulation factors. RESULTS: The patient experienced nausea and odynophagia for a period of 2 weeks following the therapy. No clinical evidence of gastrointestinal hemorrhage occurred and the patient recovered completely in a month with ingestion of a normal diet. Follow-up endoscopy three months following treatment revealed an esophageal ulcer, regression of 4 cm of the Barrett's segment, and absence of a mass on EUS. Biopsies of the epithelium did reveal Barrett's epithelium but no evidence of carcinoma. CONCLUSIONS: Photodynamic therapy for esophageal carcinoma can be conducted in the setting of severe coagulopathy and may be a viable treatment for patients who are not candidates for surgery.",
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