1143 - Radiofrequency Ablation in Barrett's Oesophagus with Dysplasia
|Application Name||Radiofrequency Ablation in Barrett's Oesophagus with Dysplasia|
|Description of Procedure or Test||Barrett's oesophagus is a metaplastic change of the lining of the oesophagus, such that the normal squamous epithelium is replaced by specialised or intestinalised columnar epithelium.|
The disorder seems to be a complication of chronic gastrooesophageal reflux disease, although asymptomatic individuals might also be affected, and it is a risk factor for the development of oesophageal adenocarcinoma, a cancer with rapidly increasing incidence in developed societies.
An appropriately sized radiofrequency (RF) ablation catheter is selected and introduced over a guidewire in a side-by-side manner with an endoscope. The catheter’s balloon is then inflated and energy applied, circumferentially ablating the epithelium to a depth of less than 1 mm. The catheter is then removed and cleaned, and reintroduced if necessary. The clinician removes the ablated epithelium using irrigation and suction using the endoscope.
|Advisory Panel||Dr Caroline Wright |
Associate Professor Michael Bilous
Dr Philip Ian Craig
Dr Peter Tagkalidis
Professor Reginald Vincent Norrie Lord
Upper Gastrointestinal Surgeon
Dr David Whiteman
Mrs Juli Ferguson
Consumer's Health Forum nominee
|Date Received by MSAC Secretariat||13/10/2009|
|Stage 1 - Eligibility||24/11/2009|
|Stage 2 - Assessment||Completed|
|Stage 3 - Formulation of Advice to the Minister||On the basis of its high cost and uncertainty of clinical benefit due to uncertainty of progression rate from Barrett’s Oesophagus with low grade dysplasia (LGD) to oesophageal cancer, MSAC does not support public funding for radiofrequency ablation (RFA) in the treatment of Barrett’s Oesophagus with LGD.
Based on a better safety profile and lower cost than oesophagectomy, but noting lack of evidence of comparative clinical effectiveness, MSAC supports public funding for RFA for Barrett’s Oesophagus with high grade dysplasia (HGD). MSAC advises that the diagnosis of HGD should be confirmed by two expert pathologists with experience in upper gastrointestinal pathology, that treatment options for patients with HGD should be reviewed by an appropriate multi-disciplinary team, and that RFA should be performed (where indicated) by an appropriately qualified specialist gastroenterologist or surgeon who has received specific training in the procedure.
|Stage 4 - Decision|
Noting of MSAC advice by the Minister does not constitute a final decision in relation to the provision of public funding.
|MSAC considered this assessment on 2 December 2010.|
The Minister noted MSAC's advice on 23 March 2011.
|Stage 5 - Implementation||In progress|
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