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 squamous dysplasia of the oesophagus in July 2014.

Description

Squamous dysplasia of the oesophagus consists of flat premalignant epithelial lesions that may progress to squamous cell carcinoma. Histological features of squamous dysplasia include cellular disorganisation, loss of polarity and downward growth of the epithelium. Cytological abnormalities include hyperchromasia, increased nucleus to cytoplasm ratio, and mitotic activity. The World Health Organization’s (WHO) histologic classification of gastrointestinal tumours refers to squamous dysplasia as squamous intra-epithelial neoplasia (defined as non-invasive cytological or architectural alterations that may lead to development of invasive cancer) and categorises it as either low- or high-grade. Low-grade squamous neoplasia is associated with a low risk of progression to invasive squamous cell carcinoma. Histological and cytological changes are moderate and involve the lower half of the epithelium. High-grade intraepithelial neoplasia carries a higher risk of progression to invasive squamous cell carcinoma. Abnormalities involve the upper half of the epithelium, and cytological changes are greater than those in low-grade intraepithelial neoplasia.

Squamous cancer of the oesophagus can be treated by surgery (oesophagectomy) or chemoradiotherapy or a combination of these methods. When the disease is detected at an earlier pre-invasive stage such as carcinoma in situ or high-grade dysplasia, then endoscopic treatment is possible. Methods include removal by endoscopic mucosal resection or endoscopic submucosal dissection, and ablation using photodynamic therapy, argon plasma coagulation, laser ablation, cryotherapy or multipolar electrocoagulation.

Coding recommendations

G14.5 Fibreoptic endoscopic destruction of lesion of oesophagus NEC

Y13.4 Radiofrequency controlled thermal destruction of lesion of organ NOC

Includes: Radiofrequency ablation of lesion of organ NOC

When the examination is not limited to the oesophagus, the following OPCS-4 codes are assigned:

G43.5 Fibreoptic endoscopic destruction of lesion of upper gastrointestinal tract NEC

Y13.4 Radiofrequency controlled thermal destruction of lesion of organ NOC

Includes: Radiofrequency ablation of lesion of organ NOC

Z27.1 Oesophagus

The Clinical Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.

Your responsibility

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.

  • National Institute for Health and Care Excellence (NICE)