Description:
Barrett's oesophagus is a condition characterised by an abnormal lining of the oesophagus, which occurs in patients with a long history of gastro-oesophageal reflux disease.
In a minority of people, Barrett's oesophagus may progress through a number of increasingly severe series of stages (dysplasia) to cancer. High-grade dysplasia is the stage which immediately precedes the occurrence of cancer, but it is not possible to predict how soon cancer will develop.
Oesophagectomy is the most radical treatment option for high-grade dysplasia, because removal of the whole oesophagus means that the risk of progression to cancer is removed. However, oesophagectomy is a major operation with the potential for morbidity and mortality. Less invasive treatments include laser ablation, endoscopic mucosal resection and photodynamic therapy. All of these procedures aim to ablate the specialised columnar epithelium which is affected by dysplasia and to promote the regeneration of normal squamous epithelium.
Photodynamic therapy involves the administration of a photosensitising agent by intravenous injection. The agent is then activated by the application of light to the selected area, usually with a low-power laser. It absorbs the energy from the light, resulting in the formation of high-energy oxygen molecules. These molecules interact with the tissue, leading to tumour necrosis by a photochemical rather than a thermal effect.
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