Photodynamic therapy for high-grade dysplasia in Barrett's oesophagus
Summary
The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Nothern Ireland on photodynamic therapy for high-grade dysplasia in Barrett's oesophagus.
NICE has reviewed this guidance and is reassessing the procedure. New guidance will be published as a result. Until the new guidance is published the NHS should continue to follow the recommendations in the guidance below.
The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an Interventional Procedures Consultation Document about its safety and efficacy for 4 weeks public consultation. IPAC will then review the consultation document in the light of comments received and produce a Final Interventional Procedures Document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
If you wish to be updated to any developments with this procedure, you can express an interest here.
Description
Barrett's oesophagus is a condition characterised by an abnormal lining of the oesophagus, which occurs in patients with a long history of gastro-oesophageal reflux disease.
In a minority of people, Barrett's oesophagus may progress through a number of increasingly severe series of stages (dysplasia) to cancer. High-grade dysplasia is the stage which immediately precedes the occurrence of cancer, but it is not possible to predict how soon cancer will develop.
Oesophagectomy is the most radical treatment option for high-grade dysplasia, because removal of the whole oesophagus means that the risk of progression to cancer is removed. However, oesophagectomy is a major operation with the potential for morbidity and mortality. Less invasive treatments include laser ablation, endoscopic mucosal resection and photodynamic therapy. All of these procedures aim to ablate the specialised columnar epithelium which is affected by dysplasia and to promote the regeneration of normal squamous epithelium.
Photodynamic therapy involves the administration of a photosensitising agent by intravenous injection. The agent is then activated by the application of light to the selected area, usually with a low-power laser. It absorbs the energy from the light, resulting in the formation of high-energy oxygen molecules. These molecules interact with the tissue, leading to tumour necrosis by a photochemical rather than a thermal effect.
OPCS code:
Details
Surgical procedures
- Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland
- British Society of Gastroenterology
Contact details:
(for general enquiries or comments)
(for procedure specific enquiries or comments)
ip@nice.org.uk
Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA
