Squamous Overgrowth Is Not a Safety Concern for Photodynamic Therapy for Barrett's Esophagus With High-Grade Dysplasia

Mary P. Bronner, Bergein F. Overholt, Shari L. Taylor, Rodger C. Haggitt, Kenneth Ke Ning Wang, J. Steven Burdick, Charles J. Lightdale, Michael Kimmey, Hector R. Nava, Michael V. Sivak, Norman Nishioka, Hugh Barr, Marcia I. Canto, Norman Marcon, Marcos Pedrosa, Michael Grace, Michelle Depot

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background & Aims: Photodynamic therapy with porfimer sodium combined with acid suppression (PHOPDT) is used to treat patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD). A 5-year phase 3 trial was conducted to determine the extent of squamous overgrowth of BE with HGD after PHOPDT. Methods: Squamous overgrowth was compared in patients with BE with HGD randomly assigned (2:1) to receive PHOPDT (n = 138) or 20 mg omeprazole twice daily (n = 70). Patients underwent 4-quadrant jumbo esophageal biopsies every 2 cm throughout the pretreatment length of BE until 4 consecutive quarterly follow-up results were negative for HGD and then biannually up to 5 years or treatment failure. Endoscopies were reviewed by blinded gastroenterology pathologists. Results: Histologic assessment of 33,658 biopsies showed no significant difference (P > .05) in squamous overgrowth between groups when compared per patient (30% vs 33%) or per biopsy (0.5% vs 1.3%), or when the average number of biopsies with squamous overgrowth were compared per patient (0.48 vs 0.66). The highest grade of neoplasia per endoscopy was not found exclusively beneath squamous mucosa in any patient. Conclusions: No difference was observed in squamous overgrowth between patients given PHOPDT plus omeprazole compared with only omeprazole. Squamous overgrowth did not obscure the most advanced neoplasia in any patient. Treatment of HGD with PHOPDT in patients with BE does not present a long-term risk of failure to detect subsquamous dysplasia or carcinoma.

Original languageEnglish (US)
Pages (from-to)56-64
Number of pages9
JournalGastroenterology
Volume136
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Barrett Esophagus
Photochemotherapy
Safety
Omeprazole
Biopsy
Endoscopy
Dihematoporphyrin Ether
Gastroenterology
Treatment Failure
Neoplasms
Mucous Membrane
Carcinoma
Acids

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Squamous Overgrowth Is Not a Safety Concern for Photodynamic Therapy for Barrett's Esophagus With High-Grade Dysplasia. / Bronner, Mary P.; Overholt, Bergein F.; Taylor, Shari L.; Haggitt, Rodger C.; Wang, Kenneth Ke Ning; Burdick, J. Steven; Lightdale, Charles J.; Kimmey, Michael; Nava, Hector R.; Sivak, Michael V.; Nishioka, Norman; Barr, Hugh; Canto, Marcia I.; Marcon, Norman; Pedrosa, Marcos; Grace, Michael; Depot, Michelle.

In: Gastroenterology, Vol. 136, No. 1, 01.2009, p. 56-64.

Research output: Contribution to journalArticle

Bronner, MP, Overholt, BF, Taylor, SL, Haggitt, RC, Wang, KKN, Burdick, JS, Lightdale, CJ, Kimmey, M, Nava, HR, Sivak, MV, Nishioka, N, Barr, H, Canto, MI, Marcon, N, Pedrosa, M, Grace, M & Depot, M 2009, 'Squamous Overgrowth Is Not a Safety Concern for Photodynamic Therapy for Barrett's Esophagus With High-Grade Dysplasia', Gastroenterology, vol. 136, no. 1, pp. 56-64. https://doi.org/10.1053/j.gastro.2008.10.012
Bronner, Mary P. ; Overholt, Bergein F. ; Taylor, Shari L. ; Haggitt, Rodger C. ; Wang, Kenneth Ke Ning ; Burdick, J. Steven ; Lightdale, Charles J. ; Kimmey, Michael ; Nava, Hector R. ; Sivak, Michael V. ; Nishioka, Norman ; Barr, Hugh ; Canto, Marcia I. ; Marcon, Norman ; Pedrosa, Marcos ; Grace, Michael ; Depot, Michelle. / Squamous Overgrowth Is Not a Safety Concern for Photodynamic Therapy for Barrett's Esophagus With High-Grade Dysplasia. In: Gastroenterology. 2009 ; Vol. 136, No. 1. pp. 56-64.
@article{2ffd196ac0004cf2ba2991ec34ec5cf3,
title = "Squamous Overgrowth Is Not a Safety Concern for Photodynamic Therapy for Barrett's Esophagus With High-Grade Dysplasia",
abstract = "Background & Aims: Photodynamic therapy with porfimer sodium combined with acid suppression (PHOPDT) is used to treat patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD). A 5-year phase 3 trial was conducted to determine the extent of squamous overgrowth of BE with HGD after PHOPDT. Methods: Squamous overgrowth was compared in patients with BE with HGD randomly assigned (2:1) to receive PHOPDT (n = 138) or 20 mg omeprazole twice daily (n = 70). Patients underwent 4-quadrant jumbo esophageal biopsies every 2 cm throughout the pretreatment length of BE until 4 consecutive quarterly follow-up results were negative for HGD and then biannually up to 5 years or treatment failure. Endoscopies were reviewed by blinded gastroenterology pathologists. Results: Histologic assessment of 33,658 biopsies showed no significant difference (P > .05) in squamous overgrowth between groups when compared per patient (30{\%} vs 33{\%}) or per biopsy (0.5{\%} vs 1.3{\%}), or when the average number of biopsies with squamous overgrowth were compared per patient (0.48 vs 0.66). The highest grade of neoplasia per endoscopy was not found exclusively beneath squamous mucosa in any patient. Conclusions: No difference was observed in squamous overgrowth between patients given PHOPDT plus omeprazole compared with only omeprazole. Squamous overgrowth did not obscure the most advanced neoplasia in any patient. Treatment of HGD with PHOPDT in patients with BE does not present a long-term risk of failure to detect subsquamous dysplasia or carcinoma.",
author = "Bronner, {Mary P.} and Overholt, {Bergein F.} and Taylor, {Shari L.} and Haggitt, {Rodger C.} and Wang, {Kenneth Ke Ning} and Burdick, {J. Steven} and Lightdale, {Charles J.} and Michael Kimmey and Nava, {Hector R.} and Sivak, {Michael V.} and Norman Nishioka and Hugh Barr and Canto, {Marcia I.} and Norman Marcon and Marcos Pedrosa and Michael Grace and Michelle Depot",
year = "2009",
month = "1",
doi = "10.1053/j.gastro.2008.10.012",
language = "English (US)",
volume = "136",
pages = "56--64",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Squamous Overgrowth Is Not a Safety Concern for Photodynamic Therapy for Barrett's Esophagus With High-Grade Dysplasia

AU - Bronner, Mary P.

AU - Overholt, Bergein F.

AU - Taylor, Shari L.

AU - Haggitt, Rodger C.

AU - Wang, Kenneth Ke Ning

AU - Burdick, J. Steven

AU - Lightdale, Charles J.

AU - Kimmey, Michael

AU - Nava, Hector R.

AU - Sivak, Michael V.

AU - Nishioka, Norman

AU - Barr, Hugh

AU - Canto, Marcia I.

AU - Marcon, Norman

AU - Pedrosa, Marcos

AU - Grace, Michael

AU - Depot, Michelle

PY - 2009/1

Y1 - 2009/1

N2 - Background & Aims: Photodynamic therapy with porfimer sodium combined with acid suppression (PHOPDT) is used to treat patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD). A 5-year phase 3 trial was conducted to determine the extent of squamous overgrowth of BE with HGD after PHOPDT. Methods: Squamous overgrowth was compared in patients with BE with HGD randomly assigned (2:1) to receive PHOPDT (n = 138) or 20 mg omeprazole twice daily (n = 70). Patients underwent 4-quadrant jumbo esophageal biopsies every 2 cm throughout the pretreatment length of BE until 4 consecutive quarterly follow-up results were negative for HGD and then biannually up to 5 years or treatment failure. Endoscopies were reviewed by blinded gastroenterology pathologists. Results: Histologic assessment of 33,658 biopsies showed no significant difference (P > .05) in squamous overgrowth between groups when compared per patient (30% vs 33%) or per biopsy (0.5% vs 1.3%), or when the average number of biopsies with squamous overgrowth were compared per patient (0.48 vs 0.66). The highest grade of neoplasia per endoscopy was not found exclusively beneath squamous mucosa in any patient. Conclusions: No difference was observed in squamous overgrowth between patients given PHOPDT plus omeprazole compared with only omeprazole. Squamous overgrowth did not obscure the most advanced neoplasia in any patient. Treatment of HGD with PHOPDT in patients with BE does not present a long-term risk of failure to detect subsquamous dysplasia or carcinoma.

AB - Background & Aims: Photodynamic therapy with porfimer sodium combined with acid suppression (PHOPDT) is used to treat patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD). A 5-year phase 3 trial was conducted to determine the extent of squamous overgrowth of BE with HGD after PHOPDT. Methods: Squamous overgrowth was compared in patients with BE with HGD randomly assigned (2:1) to receive PHOPDT (n = 138) or 20 mg omeprazole twice daily (n = 70). Patients underwent 4-quadrant jumbo esophageal biopsies every 2 cm throughout the pretreatment length of BE until 4 consecutive quarterly follow-up results were negative for HGD and then biannually up to 5 years or treatment failure. Endoscopies were reviewed by blinded gastroenterology pathologists. Results: Histologic assessment of 33,658 biopsies showed no significant difference (P > .05) in squamous overgrowth between groups when compared per patient (30% vs 33%) or per biopsy (0.5% vs 1.3%), or when the average number of biopsies with squamous overgrowth were compared per patient (0.48 vs 0.66). The highest grade of neoplasia per endoscopy was not found exclusively beneath squamous mucosa in any patient. Conclusions: No difference was observed in squamous overgrowth between patients given PHOPDT plus omeprazole compared with only omeprazole. Squamous overgrowth did not obscure the most advanced neoplasia in any patient. Treatment of HGD with PHOPDT in patients with BE does not present a long-term risk of failure to detect subsquamous dysplasia or carcinoma.

UR - http://www.scopus.com/inward/record.url?scp=59849089442&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=59849089442&partnerID=8YFLogxK

U2 - 10.1053/j.gastro.2008.10.012

DO - 10.1053/j.gastro.2008.10.012

M3 - Article

VL - 136

SP - 56

EP - 64

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 1

ER -