The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Photodynamic therapy for Barrett's oesophagus.
It replaces the previous guidance on Photodynamic therapy for Barrett's oesophagus (NICE interventional procedure guidance 82, August 2004).
Further recommendations have been made as part of the clinical guideline on Barrett's oesophagus - ablative therapy published in August 2010, as follows:
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.
Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. More information is available from NICE clinical guidance 106. The IP guidance on photodynamic therapy for Barrett's oesophagus remains current, and should be read in conjunction with the clinical guideline.
Barrett’s oesophagus is a condition in which the internal lining of the gullet (oesophagus) becomes damaged by long-term leaking of the stomach contents back into the gullet, known as ‘reflux’. Some patients with Barrett’s oesophagus may go on to develop cancer of the oesophagus. In photodynamic therapy, the patient is injected with a drug that makes the affected lining of the oeosophagus sensitive to light. Some hours after this a laser light source is passed down into the oesophagus where it is used to start a reaction that destroys the abnormal lining of the oesophagus, with the aim of preventing the progression to cancer.
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, and specifically any special arrangements relating to the introduction of new interventional procedures. 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.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
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. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
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.