Australian Government - Department of Health and Ageing

Medical Services Advisory Committee (MSAC)

1143 - Radiofrequency Ablation in Barrett's Oesophagus with Dysplasia

Assessment No

1143
Application NameRadiofrequency Ablation in Barrett's Oesophagus with Dysplasia
Description of Procedure or TestBarrett'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 PanelDr Caroline Wright
Chair
MSAC Member
Colorectal Surgeon
Associate Professor Michael Bilous
Deputy Chair
MSAC Member
Pathologist
Dr Philip Ian Craig
Gastroenerologist
Dr Peter Tagkalidis
Gastroenetrologist
Professor Reginald Vincent Norrie Lord
Upper Gastrointestinal Surgeon
Dr David Whiteman
Epidemiologist
Mrs Juli Ferguson
Consumer's Health Forum nominee
Date Received by MSAC Secretariat13/10/2009
Stage 1 - Eligibility24/11/2009
Stage 2 - AssessmentCompleted
Stage 3 - Formulation of Advice to the MinisterOn 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 - ImplementationIn progress