The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of non-ampullary duodenal lesions.
This procedure can be used to treat abnormalities in the lining of the part of the small intestine near the stomach (the duodenum). A long camera (endoscope) is inserted through the mouth, oesophagus and stomach to view the affected area. A solution is injected into the wall of the duodenum, and then the abnormal parts of the lining are removed with special instruments. The aim of the procedure is to avoid the need for open surgery, and to obtain a good-quality sample for examination under the microscope.
Endoscopic submucosal dissection of duodenal lesions:
When performed with examination or other therapeutic procedures of other parts of the upper gastrointestinal tract the following OPCS-4 codes are assigned:
G42.1 Fibreoptic endoscopic submuscosal resection of lesion of upper gastrointestinal tract
Endoscopic mucosal resection of duodenal lesions:
When performed along with examination or other therapeutic procedures of other parts of the upper gastrointestinal tract at the same time, one of the following 3 codes is assigned:
G43.1 Fibreoptic endoscopic snare resection of lesion of upper gastrointestinal tract
G43.8 Other specified fibreoptic endoscopic extirpation of lesion of upper gastrointestinal tract
G43.9 Unspecified fibreoptic endoscopic extirpation of lesion of upper gastrointestinal tract
With the addition of a subsidiary site code Z27.4 Duodenum.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. 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.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.