The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endoscopic radiofrequency ablation for gastro-oesophageal reflux disease.
This guidance updates replaces NICE interventional procedure 292 (March 2009).
Gastro-oesophageal reflux disease (GORD) is a common problem and is caused by a variety of conditions that disturb the sphincter function at the lower end of the oesophagus, such as hiatus hernia. Symptoms of GORD can be broadly grouped into those directly related to reflux episodes, such as heartburn, regurgitation, chest pain and nausea and those symptoms caused by complications of reflux disease, including dysphagia, respiratory difficulties, Barrett's oesophagus or oesophageal stricture.
Lifestyle modification and drug therapy are the standard treatments for patients with symptomatic GORD. Drug therapy includes antacids, alginates and acid-lowering agents such as H2-receptor antagonists and proton pump inhibitors (PPIs). Patients who have refractory symptoms, who develop complications despite medication or who develop intolerance to medication, may be considered for anti-reflux surgery (usually laparoscopic fundoplication). Fundoplication involves wrapping the uppermost part of the stomach around the distal oesophagus, by an open or laparoscopic approach. A number of alternative endoscopic techniques have also been used.
G44.8 Other specified other therapeutic fibreoptic endoscopic operations on upper gastrointestinal tract
Y11.4 Radiofrequency controlled thermal destruction of organ NOC
Includes: Radiofrequency ablation of organ NOC
O11.1 Gastro-oesophageal junction
In addition an ICD-10 code from category K21.- Gastro-oesophageal reflux disease is assigned.
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.