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Barrett’s oesophagus

About

What is covered

This pathway covers the treatment of adults (age 18 and older) with Barrett's oesophagus who have high-grade dysplasia or early intramucosal cancer.
Barrett's oesophagus can develop following chronic gastro-oesophageal reflux disease. It is characterised by abnormal changes in the oesophageal epithelium. In some patients, these may become dysplastic and lead to oesophageal cancer.
Oesophagectomy is the standard treatment for high-grade dysplastic Barrett's or intramucosal cancer (including T1a) but is associated with significant mortality and morbidity. Less invasive surgical techniques have been developed and are being used as alternatives.
This pathway covers the use of ablative therapies (argon plasma coagulation, laser ablation, multipolar electrocoagulation, radiofrequency ablation and photodynamic therapy) and endoscopic mucosal resection for treating Barrett's oesophagus with high-grade dysplasia or with early intramucosal cancer.

Updates

Updates to this pathway

22 July 2014 Endoscopic radiofrequency ablation for Barrett's oesophagus with low-grade dysplasia or no dysplasia (NICE interventional procedure guidance 496) added to the node on Barrett's oesophagus with low-grade dysplasia or no dysplasia.
12 May 2014 Minor maintenance update.
2 January 2014 Minor maintenance update.
27 August 2013 Minor maintenance update.
30 July 2013 Minor maintenance update.
31 May 2013 Minor maintenance update.

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart 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.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
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.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart 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 recommendations, 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 interactive flowchart 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.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Treating people with Barrett's oesophagus who have high-grade dysplasia or early intramucosal cancer

What is covered

This pathway covers the treatment of adults (age 18 and older) with Barrett's oesophagus who have high-grade dysplasia or early intramucosal cancer.
Barrett's oesophagus can develop following chronic gastro-oesophageal reflux disease. It is characterised by abnormal changes in the oesophageal epithelium. In some patients, these may become dysplastic and lead to oesophageal cancer.
Oesophagectomy is the standard treatment for high-grade dysplastic Barrett's or intramucosal cancer (including T1a) but is associated with significant mortality and morbidity. Less invasive surgical techniques have been developed and are being used as alternatives.
This pathway covers the use of ablative therapies (argon plasma coagulation, laser ablation, multipolar electrocoagulation, radiofrequency ablation and photodynamic therapy) and endoscopic mucosal resection for treating Barrett's oesophagus with high-grade dysplasia or with early intramucosal cancer.

Updates

Updates to this pathway

22 July 2014 Endoscopic radiofrequency ablation for Barrett's oesophagus with low-grade dysplasia or no dysplasia (NICE interventional procedure guidance 496) added to the node on Barrett's oesophagus with low-grade dysplasia or no dysplasia.
12 May 2014 Minor maintenance update.
2 January 2014 Minor maintenance update.
27 August 2013 Minor maintenance update.
30 July 2013 Minor maintenance update.
31 May 2013 Minor maintenance update.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Minimally invasive oesophagectomy. NICE interventional procedure guidance 407 (2011)
Endoscopic submucosal dissection of oesophageal dysplasia and neoplasia. NICE interventional procedure guidance 355 (2010)
Photodynamic therapy for Barrett's oesophagus. NICE interventional procedure guidance 350 (2010)
Epithelial radiofrequency ablation for Barrett's oesophagus. NICE interventional procedure guidance 344 (2010)
Photodynamic therapy for early-stage oesophageal cancer. NICE interventional procedure guidance 200 (2006)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart 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.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
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.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart 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 recommendations, 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 interactive flowchart 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.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Glossary

Paths in this pathway

Pathway created: October 2012 Last updated: February 2016

© NICE 2017

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