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Barrett’s Oesophagus

Ablative Therapy for the Treatment of Barrett’s Oesophagus

NICE Clinical Guidelines, No. 106

Centre for Clinical Practice at NICE (UK).

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Excerpt

Barrett’s oesophagus develops as a consequence of chronic gastro-oesophageal reflux disease. It is characterised by abnormal changes in the oesophageal lining that may, in some patients, become dysplastic and lead to oesophageal cancer. Oesophagectomy (surgical removal of the oesophagus) is the standard NHS treatment for high-grade dysplastic Barrett’s oesophagus or intramucosal cancer (including T1a); however, it is associated with significant mortality and morbidity. Consequently less invasive surgical techniques, such as endoscopic mucosal resection, and ablative treatments have been developed and are being used as alternatives for patients who are unsuitable for surgery or who express a preference for less invasive options. However, in the past there has been uncertainty whether ablative therapy for Barrett’s oesophagus is both clinically and cost effective compared with other management options.

Radiofrequency ablation is one of the ablative therapies currently being used. This has a standard depth of ablation that is set by the manufacturer. Photodynamic therapy has a greater depth of ablation than radiofrequency ablation, irrespective of the photosensitiser used (although only one photosensitiser (porfirmer sodium) is presently licensed in the UK). However greater depth of ablation is associated with higher rate of complications but clinicians do not control the depth and is dependent on the ablative therapy used.

Previously no evidence-based guideline has addressed the use of ablative therapies for the treatment of Barrett’s oesophagus in England and Wales, which may lead to variation in practice. This clinical guideline covers the use of ablative therapies (argon plasma coagulation, laser ablation, multipolar electrocoagulation, radiofrequency ablation and photodynamic therapy) and endoscopic mucosal resection compared with oesophageal surgery, and surveillance with proton-pump inhibitors for treating Barrett’s oesophagus with high-grade dysplasia or with early intramucosal cancer in adults (18 years and older) in secondary care.

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NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales.

This guidance represents the view of NICE, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, and informed by the summary of product characteristics of any drugs they are considering.

Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Copyright © 2010, National Institute for Health and Clinical Excellence.

All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of NICE.

PMID: 23115813

NICE (National Institute for Health and Care Excellence)

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