Name of the Procedure:

Photodynamic Therapy (PDT) by Endoscopic Application of Light to Ablate Abnormal Tissue via Activation of Photosensitive Drug(s)

Summary

Photodynamic Therapy (PDT) uses a combination of light and special drugs, known as photosensitizing agents, to destroy abnormal tissue. During the procedure, these drugs are activated by a specific wavelength of light delivered through an endoscope, targeting and treating the affected area.

Purpose

This procedure is used to treat certain types of cancers and precancers in the lung and gastrointestinal tract. The goal is to destroy abnormal or malignant cells while minimizing damage to surrounding healthy tissue, reducing the need for more invasive surgical procedures.

Indications

• Early-stage lung cancer or pre-cancerous lesions
• Barrett's esophagus with dysplasia
• Superficial esophageal cancer
• Non-small cell lung cancer localized to the airways
• Selected patients with cholangiocarcinoma or bile duct cancer

Preparation

• Fasting for several hours before the procedure
• Adjustments to medications as advised by the doctor (e.g., stopping blood thinners)
• Pre-procedure diagnostic tests, including imaging studies or endoscopy to precisely locate the abnormal tissue

Procedure Description

1. The patient receives an intravenous injection of a photosensitizing drug, which accumulates more in abnormal cells.
2. After an incubation period to allow the drug to concentrate in the target tissues, the patient undergoes endoscopy.
3. A fiber-optic catheter attached to the endoscope delivers a specific wavelength of light to the treated area.
4. The light activates the photosensitizing agent, creating a reaction that destroys abnormal cells.
5. The endoscope is removed, and the patient is monitored for immediate post-procedure effects.

Tools and equipment:

• Photosensitizing agents (e.g., porfimer sodium)
• Endoscope with light delivery device
• Fiber-optic catheters

Sedation:

• Local anesthesia, conscious sedation, or general anesthesia depending on the extent of the procedure.

Duration

The procedure typically lasts about 30 minutes or longer, depending on the treated area and the number of sites.

Setting

PDT is usually performed in a hospital, outpatient clinic, or surgical center equipped with the necessary endoscopic and light delivery technology.

Personnel

• Gastroenterologist, Pulmonologist, or Oncologist specializing in endoscopic procedures
• Nurses and surgical technologists
• Anesthesiologist or nurse anesthetist if sedation is used

Risks and Complications

• Photosensitivity reactions (skin and eye sensitivity to light)
• Swelling or inflammation at the treatment site
• Difficulty swallowing or breathing if the treated area swells significantly
• Infection risks
• Possible damage to healthy tissues, but this is minimized due to targeted light activation

Benefits

• Minimally invasive, preserving more surrounding healthy tissue
• Targeted destruction of abnormal cells
• Reduced need for more extensive surgery
• Potential immediate relief of symptoms, improved quality of life

Recovery

• Avoid direct sunlight or strong indoor light for several weeks post-procedure to prevent photosensitivity reactions
• Pain management with prescribed medications
• Follow-up appointments to monitor healing and evaluate the effectiveness
• Gradual return to normal activities as advised

Alternatives

• Surgical resection of the affected area (more invasive)
• Radiation therapy
• Chemotherapy
• Watchful waiting in certain cases, with regular monitoring

Pros and cons:

• PDT is less invasive, has quicker recovery, and typically fewer side effects compared to surgery but may require multiple sessions, and effectiveness depends on the extent of tissue involvement.

Patient Experience

• During the procedure: Sedation helps manage discomfort. Patients might feel pressure or mild discomfort.
• After the procedure: Sensitivity to light requires careful management; discomfort at the treatment site is managed with pain relievers.
• Recovery involves light sensitivity measures, gradual resumption of activities, and monitoring for potential complications.