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Background: The gold standard treatment of early oesophageal carcinoma is oesophagectomy but the elderly population affected are often medically unfit for this radical intervention and less invasive curative options are required. We describe our experience of porfimer sodium photodynamic therapy (PDT) as an alternative to surgery in such a patient group., Methods: From 1999 to 2005 28 oesophageal cancer patients were found to have early stage disease based initially on endoscopy/CT and latterly on CT/endoscopic ultrasound (EUS) criteria. Although potentially suitable for major surgical resection these patients were judged to be medically unfit and were selected to have PDT. Patients were followed up endoscopically at 6-12-week intervals indefinitely with biopsy of the treated area., Results: 18/28 patients had an initial complete response 8 weeks post procedure. One patient died before reassessment of unrelated disease. Nine patients were non-responders. 7/18 complete responders remained disease free for a mean follow up period of 1166 days (249-2019). 11/18 developed recurrent local disease treated with further PDT with a median survival of 770 days (254-2049). Fourteen patients had EUS staging which accurately predicted response: all T1N0 patients (9/14) had initial complete response to treatment although 5/9 have required further PDT. All remain disease free at a follow up of 1103 days (249-2019). No patients with T2/3N0 disease had complete response to treatment. The major complication of PDT encountered was stricture formation which occurred in 50% of cases and required a median of five dilations (range 1-31)., Conclusions: Porfimer sodium PDT is a potentially curative treatment in patients with early oesophageal carcinoma who may be unfit or unwilling to undergo major surgery.

Over the last 15 years photodynamic therapy (PDT) has become a viable treatment for pre-malignant and malignant disease of the oesophagus. Its initial use was in the palliation of oesophageal malignant obstruction bringing improved swallowing hence increasing nutritional intake and improving general quality of life. As the therapeutic boundaries of PDT have stretched, current studies look at the role of PDT in the treatment of pre-malignant dysplastic Barrett's epithelium and early malignancy as a curative mucosal ablative technique. As a curative treatment in early oesophageal cancer, PDT provides an alternative treatment to oesophagectomy for those more elderly or less medically fit patients. This paper reviews the uses of photodynamic therapy in oesophageal cancer with reference to the available publications on its use in the palliation of oesophageal cancer and treatment of early cancer and high grade dysplasia in Barrett's mucosa.

We present a novel case of an elderly patient with a Barrett's adenocarcinoma in the presence of an Angelchik prosthesis. We aim to draw attention to issues relating to metaplastic Barretts' oesphagus and its adenocarcinoma complications and highlight relevant issues in multimodal endoscopic management and palliation using photodynamic therapy in the presence of the device.