The light solution for Barrett's oesophagus Photodiagnosis and photodynamic therapy for columnar-lined oesophagus

Background: Barrett's oesophagus is the columnar-lined metaplasia that occurs in response to severe gastro-oesophageal reflux and accounts for the dramatic rise in adenocarcinoma at the gastro-oesophageal junction. Diagnostic methods: Endoscopic recognition and pathological diagnosis of the condition is fraught with erroneous interpretation of the pre-malignant degeneration of dysplasia. Screening and surveillance programmes have yet to impact on the disease. Photodiagnosis by spectroscopy and imaging is under intense investigation. The methods can be divided into two groups of morphological (elastic scattering, optical coherence tomography) and molecular and biochemical (Raman and fluorescence). The major diagnostic problem remains the differentiation between inflammation and dysplasia. Raman spectroscopy does offer molecular-specific diagnosis and fibre-optic probes are being developed. The future appears to be multi-modal imaging combined with spectroscopy. Results: Photodynamic therapy is a realistic option for the eradication of dysplastic Barrett's oesophagus. A recently reported randomised trial has demonstrated a significant improvement in the eradication of dysplasia and prevention of oesophageal cancer. Conclusions: Optical diagnosis and optical eradication have a bright future for the management of Barrett's oesophagus. (C) 2004 Elsevier B.V. All rights reserved.