MedWire News: The National Institute for Health and Clinical Excellence (NICE) in the UK has published guidelines recommending the use of ablative therapies for treatment of Barrett's esophagus (BE).

These treatments allow the destruction of the abnormal esophageal cells that characterize this condition without the need for removal of whole sections of the esophagus.

Fergus Macbeth (NICE, UK) commented: "BE, apart from being a distressing condition in itself, can sometimes lead to cancer of the esophagus. Therefore, it's important that the National Health Service (NHS) is treating it in the most clinically and cost-effective way."

He added: "This will be the first national guideline to cover the use of ablative therapies, and will ensure that the widest range of options is considered for patients suffering with this serious condition."

The current standard treatment for BE is surgical removal of all or part of the esophagus. However, this technique is invasive and unpleasant for patients and less invasive techniques such as endoscopic mucosal resection, which allows localized removal of suspect lesions via endoscopy, and ablative therapies have been developed.

The guidelines recommend that clinicians should consider offering BE patients aged 18 years or older with high-grade dysplasia or intramucosal cancer endoscopic resection as an alternative to standard esophageal surgery, bearing in mind patient preference and general health.

Endoscopic mucosal resection can be followed with additional ablative therapy - radiofrequency ablation, argon plasma coagulation or photodynamic therapy - to ensure destruction of all abnormal cells.

Radiofrequency ablation or photodynamic therapy alone can be considered as an alternative treatment to surgical or endoscopic mucosal resection for patients with flat high-grade dysplasia.

Clinicians are advised that should residual or recurrent disease occur then further endoscopic resection and/or ablative therapy may be required.

Macbeth said: "The recommendations may lead to less costly treatments, and fewer recalls and complications after treatment. Additionally, because more patients are eligible or fit enough to undergo endoscopic procedures than surgery, future savings for the NHS might come from cases of esophageal cancer avoided."

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NICE website