1 Recommendations

Guidance

1.1 Current evidence on the efficacy of endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus is inadequate in quality and quantity. With regard to safety, there are well‑recognised complications, particularly oesophageal strictures. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

1.2 Clinicians wishing to undertake endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus should take the following actions.

Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainties about the procedure's safety and efficacy, inform them about alternative treatment options and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.

1.3 Patient selection for endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus should be done by a multidisciplinary team experienced in the management of oesophageal dysplasia.

1.4 Endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus should only be done by endoscopists experienced in treating oesophageal dysplasia.

1.5 NICE encourages further research into endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus, including observational data collection. Studies should clearly define patient selection. Outcomes should include completeness of ablation, resolution of squamous dysplasia, progression to cancer and quality of life. All complications should be reported, particularly development of oesophageal strictures.

1.6 Clinicians should enter details about all patients undergoing endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus onto the UK National HALO patient register, and review clinical outcomes locally.