The National Institute for Health and Clinical Excellence (NICE) has issued new guidelines recommending that clinicians consider offering endoscopic resection (ER) of high-grade dysplasia and intramucosal cancer as an alternative to removal of the affected part of the esophagus (esophagectomy) for the treatment of Barrett's esophagus. The guidelines specify laser ablation and photodynamic therapy (PDT) among other therapies—and suggest that ER should also be considered alone to treat localized lesions.
It is the first time that NICE has issued guidelines relating to the the use of ablative therapies for the treatment of Barrett's esophagus. Ablative therapies destroy the abnormal cells within the esophagus caused by this condition, without the need to remove an entire section of the esophagus. The condition is a direct consequence of long-term, chronic gastro-esophageal reflux disease (GERD). The cells that line the affected area of the esophagus become inflamed and if this happens over many years, these cells may start to change, becoming more like the cells that line the intestine. In some patients, these changes can lead to esophageal cancer.
In the UK, around 1% of the population are currently affected by Barrett's esophagus, placing a significant cost burden on the health service and the need to select the most cost-effective and clinically beneficial therapy. The lack of any previous advice on treatment options has led to widespread variation in treatments being offered. These new guidelines subsequently set out as a clinical pathway for the treatment of Barrett's esophagus in England and Wales.