This guidance replaces the previous guidance on Photodynamic therapy for Barrett's oesophagus, 82, August 2004.
1.1 Current evidence on the efficacy of photodynamic therapy (PDT) for patients with Barrett's oesophagus with high-grade dysplasia (HGD) is adequate, provided that patients are followed up in the long term. There are no major safety concerns, although there is a risk of oesophageal stricture, and photosensitivity reactions are common. This procedure may be used in patients with Barrett's oesophagus with HGD provided that normal arrangements are in place for clinical governance, consent and audit.
1.2 Current evidence on the efficacy and safety of PDT in patients with Barrett's oesophagus with either low-grade dysplasia (LGD) or no dysplasia is inadequate in quality and quantity, and the balance of risks and benefits is not clear. Therefore, for these patients, the procedure should be used only with special arrangements for clinical governance, consent and audit or research.
1.3 Clinicians wishing to undertake PDT in patients with Barrett's oesophagus with either LGD or no dysplasia should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients and their carers understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for patients ('Understanding NICE guidance') is recommended.
Audit and review clinical outcomes of patients with Barrett's oesophagus other than HGD having PDT (see section 3.1).
1.4 Patient selection should be carried out by a multidisciplinary team experienced in the management of the condition.
1.5 PDT for Barrett's oesophagus should only be carried out by endoscopists with specific training in this procedure.