1 Guidance

The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop the guidance.

For the purposes of this guideline, the term 'endoscopic mucosal resection' is used interchangeably with 'endoscopic resection'.

1.1 List of all recommendations

Before considering endoscopic therapy as an alternative to surgery, a confirmed diagnosis of high-grade dysplasia or intramucosal cancer in Barrett's oesophagus should be agreed by a designated specialist multidisciplinary team for oesophago-gastric cancer.

Key principles of care

1.1.1 All treatments for high-grade dysplasia and intramucosal cancer in Barrett's oesophagus should be performed by specialist oesophago-gastric cancer teams with the experience and facilities to deliver the treatments recommended in this guideline.

Endoscopic therapies

1.1.2 Consider offering endoscopic therapy as an alternative to oesophagectomy to people with high-grade dysplasia and intramucosal cancer (T1a), taking into account individual patient preferences and general health. Endoscopic therapy is particularly suitable for patients who are considered unsuitable for surgery or who do not wish to undergo oesophagectomy.

Endoscopic mucosal resection

1.1.3 Consider using endoscopic mucosal resection alone to treat localised lesions.

1.1.4 Use circumferential endoscopic mucosal resection with care because of the high incidence of stricture formation.

1.1.5 If residual or recurrent disease is suspected, consider additional or repeated therapy with appropriate follow-up using:

  • endoscopic mucosal resection with further pathological assessment or

  • ablative therapy (radiofrequency ablation or photodynamic therapy) or

  • endoscopic mucosal resection and ablative therapy (radiofrequency ablation, argon plasma coagulation or photodynamic therapy).

Ablative therapies

1.1.6 Consider using radiofrequency ablation alone or photodynamic therapy alone for flat high-grade dysplasia, taking into account the evidence of their long-term efficacy, cost and complication rates.[1]

1.1.7 Do not use argon plasma coagulation, laser ablation or multipolar electrocoagulation alone, or in combination with each other, unless as part of a clinical trial.

Endoscopic mucosal resection in combination with ablative therapies

1.1.8 If using endoscopic mucosal resection, consider following with an additional ablative therapy (radiofrequency ablation, argon plasma coagulation or photodynamic therapy) to completely remove residual flat dysplasia, taking into consideration the side-effect profiles[1].

Patient and carer support and information

1.1.9 Give patients verbal and written information about their diagnosis, available treatments, patient support groups and the uncertainty of the long-term outcomes of ablative therapies. Give patients time to consider this information when making decisions about their care.

1.1.10 Discuss the multidisciplinary team's views on the range of appropriate treatments with the patient.

1.1.11 Offer patients the opportunity to see the same specialist healthcare team more than once to agree treatment.

1.1.12 Advise patients who have endoscopic therapy that they will need lifelong care and repeated endoscopies.

[1] Recommendation linked to IPG344 and IPG350.

  • National Institute for Health and Care Excellence (NICE)