• Barrett’s oesophagus
• cancer prevention
• photodynamic therapy
• thermoablation

Barrett’s oesophagus is important given the increased risk for oesophageal adenocarcinoma. However, the annual incidence rate for oesophageal adenocarcinoma is low (0.5–1%¹) and the majority of patients with Barrett’s oesophagus are undiagnosed in the population.² Therefore, in order to reduce the population morbidity and mortality of oesophageal cancer, any cancer preventive strategy needs to be cost effective and acceptable to a large number of patients at relatively low risk.

The current management guidelines for Barrett’s oesophagus advocate symptomatic treatment with acid suppressants and regular surveillance.³ Surveillance is labourious and expensive and has not been shown to alter the natural history of the condition. Hence alternatives such as mucosal ablative therapy have been advocated on the basis of small case series that show initial promise (for example, see Morris and colleagues⁴).

Mucosal ablation using either photodynamic therapy or thermoablation techniques are becoming well established for the treatment of high grade dysplasia and intramucosal carcinoma in Barrett’s …