The Medical Technology Blog

The National Institute for Health and Clinical Excellence (NICE) has issued new guidelines that recommend that clinicians consider offering patients endoscopic resection (ER) of high-grade dysplasia and intramucosal cancer, including T1a, as an alternative to removal of the affected part of the oesophagus (oesophagectomy). Additionally, ER should also be considered alone, to treat localised lesions. Oesophagectomy is the current standard NHS treatment for Barrett’s oesophagus, and this latest guidance signals a renewed focus on less invasive techniques such as ER and ablative treatments. T1a is a classification of cancer that shows less than 5 per cent of cancerous cells in the tissue sample.

The guidelines specifically cover the use of ablative therapies such as argon plasma coagulation (APC), laser ablation, multipolar electrocoagulation (MPEC), radiofrequency ablation (RFA), photodynamic therapy (PDT) and endoscopic resection (ER), for treating Barrett’s oesophagus (BO) with high-grade dysplasia or with intramucosal cancer (including T1a) in adults (18 years and older) in secondary care. The recommendations state that an additional ablative therapy (RFA, APC or PDT) could be used after ER to completely remove dysplasia, and RFA or PDT ablation alone could be considered for flat high-grade dysplasia. NICE also advises that APC, laser or MPEC should not be used alone or in combination with each other unless as part of a clinical trial.

It is the first time that NICE has issued guidelines relating to the the use of ablative therapies for the treatment of Barrett’s oesophagus. Ablative therapies destroy the abnormal cells within the oesophagus caused by this condition, without the need to remove an entire section of oesophagus. The condition is a direct consequence of long-term, chronic gastro-oesophageal reflux disease (GORD). The cells that line the affected area of the oesophagus become inflamed and if this happens over many years, these cells may start to change, becoming more like the cells that line the intestine. In some patients, these changes can lead to oesophageal cancer.

In the UK, around 1 per cent of the UK population are currently affected by Barrett’s oesophagus, placing a significant cost burden on the health service and the need to select the most cost-effective and clinically beneficial therapy. The lack of any previous advise on treatment options as led to widespread variation in treatments being offered. These new guidelines subsequently set out as a clinical pathway for the treatment of Barrett’s oesophagus in England and Wales.

Thanks to Lawrence Miller for this post, Lawrence is Espicom‘s medical newsletters team leader, and the editor of Medical Industry Week.

Please keep reading for more articles later this week, Paul.



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