Let there be light ▸

Tantalising though the evidence is, there is no clear consensus about endoscopic therapy for high grade dysplasia (HGD) or superficial adenocarcinoma complicating Barrett’s oesophagus. Data regarding photodynamic therapy (PDT) has been impressive but good quality randomised trials have been lacking.

This trial compared PDT with porfimer versus omeprazole in 208 patients with high grade dysplasia (HGD) with histological follow up for at least two years after the final patient was randomised. All biopsies were interpreted centrally by a blinded pathologist; the primary outcome measure was complete ablation of HGD at any time during follow up. Secondary end points included occurrence of cancer, duration of complete response, and time to treatment failure. Of 485 patients screened, 208 were included and followed up for up to 43 months (mean 24). Complete ablation of HGD occurred in 77% of the PDT group compared with 39% treated with omeprazole (p<0.0001), and at each time point approximately twice as many PDT patients achieved ablation. Median duration of …