Introduction

Introduction

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.

  • National Institute for Health and Care Excellence (NICE)