Porfimer: new drug. Endobrachyesophagus: encouraging preliminary results

(1) Patients with endobrachyesophagus (Barrett's oesophagus) and high-grade dysplasia are at high risk of developing adenocarcinoma within 3 to 7 years. Esophagectomy carries a risk of major morbidity and mortality. Local treatments (photocoagulation and endoscopic mucosectomy) are currently under evaluation. (2) Marketing authorisation has been granted for a photodynamic treatment based on intravenous porfimer injection and laser illumination of the lesion. (3) In a randomised trial comparing porfimer photodynamic therapy plus omeprazole with omeprazole alone, 208 patients were monitored for at least 2 years. There was no difference in mortality between the groups. Thirteen percent of patients on combination treatment developed adenocarcinoma (stage not specified), compared to 29% of patients treated with omeprazole alone (p = 0.006). Nearly half the patients had symptoms of photosensitization, and 38% had oesophageal contraction requiring at least 1 dilation session. (4) In practice, despite some encouraging results, we do not know if photodynamic therapy based on porfimer reduces the long-term risk of recurrence, invasive carcinoma, or major surgery. However, there is a risk of serious adverse effects. Porfimer photodynamic therapy needs to be compared with other endoscopic interventions.