The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Stent insertion for bleeding oesophageal varices.
It replaces the previous guidance on stent insertion for bleeding oesophageal varices (NICE interventional procedures guidance 265, June 2008).
People who drink heavily or who have hepatitis C may develop liver cirrhosis (scarring). This may cause bleeding arising from swollen veins in the gullet (oesophagus), which is potentially life threatening. This procedure involves temporary insertion of a tube-shaped mesh covered in plastic (called a stent) into the oesophagus. The stent is expanded to the width of the gullet so that it presses against the veins with the aim of stopping the bleeding. The stent is removed within 2 weeks.
One of the following OPCS-4 codes is selected as appropriate:
G21.5 Insertion of stent into oesophagus NEC
G15.4 Fibreoptic endoscopic insertion of tubal prosthesis into oesophagus
G15.6 Fibreoptic endoscopic insertion of expanding metal stent into oesophagus NEC
G15.7 Fibreoptic endoscopic insertion of expanding covered metal stent into oesophagus
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.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.