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  • Endoscopic ultrasound for

    evaluating pancreatic,

    gastric, oesophageal

    and hepatobiliary

    neoplasms

    November 2006

    MSAC application 1072

    Assessment report

  • © Commonwealth of Australia 2007

    ISBN (Print) 1-74186-199-3

    ISBN (Online) 1-74186-200-0

    ISSN (Print) 1443-7120

    ISSN (Online) 1443-7139

    First printed November 2007

    Paper-based publications

    © Commonwealth of Australia 2007 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General’s Department, Robert Garran Offices, National Circuit, Canberra ACT 2600 or posted at http://www.ag.gov.au/cca

    Internet sites

    © Commonwealth of Australia 2007 This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General’s Department, Robert Garran Offices, National Circuit, Canberra ACT 2600 or posted at http://www.ag.gov.au/cca

    Electronic copies of the report can be obtained from the Medical Service Advisory Committee’s Internet site at http://www.msac.gov.au/

    Printed copies of the report can be obtained from:

    The Secretary Medical Services Advisory Committee Department of Health and Ageing Mail Drop 106 GPO Box 9848 Canberra ACT 2601

    Enquiries about the content of the report should be directed to the above address.

    The Medical Services Advisory Committee (MSAC) is an independent committee which has been established to provide advice to the Commonwealth Minister for Health and Ageing on the strength of evidence available on new and existing medical technologies and procedures in terms of their safety, effectiveness and cost-effectiveness. This advice will help to inform Government decisions about which medical services should attract funding under Medicare.

    MSAC recommendations do not necessarily reflect the views of all individuals who participated in the MSAC evaluation.

    This report was prepared by the Medical Services advisory Committee with the assistance of Dr Suzanne Dyer, Dr John Gillespie, Ms Meaghan Lynch, Mr Marc Bevan, Ms Jolie Hutchinson, Dr Amanda Ruth and Mr Dane Levison from the Medical Technology Assessment Group (M-TAG) a unit of IMS Health. Ms Ann Jones of M-TAG edited the report. The Commonwealth Minister for Health and Ageing endorsed the report on 5 February 2007.

    Publication approval number: P3-1287

  • Endoscopic ultrasound iii

    Contents

    Executive summary.............................................................................................. xiv The procedure............................................................................................................................xiv Medical Services Advisory Committee—role and approach ...............................................xv MSAC’s assessment of endoscopic ultrasound......................................................................xv

    Clinical need...................................................................................................................xv Safety..............................................................................................................................xvi Effectiveness................................................................................................................xvii Cost-effectiveness ......................................................................................................xxiv

    Recommendation.....................................................................................................................xxvi

    Introduction ............................................................................................................ 1

    Background ............................................................................................................2 Endoscopic ultrasound................................................................................................................2

    The procedure .................................................................................................................2 Intended purpose ............................................................................................................4 Complications..................................................................................................................4

    The reference standard ................................................................................................................5 Existing tests .................................................................................................................................5

    Oesophageal and gastric neoplasia ...............................................................................5 Pancreaticobiliary neoplasia...........................................................................................7 Pancreatic neuroendocrine tumours ............................................................................9

    Oesophageal neoplasia...............................................................................................................10 Clinical need...................................................................................................................10 Current treatment..........................................................................................................12

    Gastric neoplasia.........................................................................................................................13 Clinical need...................................................................................................................13 Current treatment..........................................................................................................16

    Pancreatic neoplasia ...................................................................................................................17 Clinical need...................................................................................................................17 Current treatment..........................................................................................................21

    Biliary tract neoplasia .................................................................................................................23 Clinical need...................................................................................................................23 Current treatment..........................................................................................................24

    Potential impact of the test .......................................................................................................25 Marketing status of the device/technology ............................................................................26 Current reimbursement arrangement ......................................................................................26

    Approach to assessment ....................................................................................... 27 Management and health outcomes ..........................................................................................27

    Assessment framework ................................................................................................27 Review of the literature ................................................................................................27

    Oesophageal neoplasia...............................................................................................................29 Research question .........................................................................................................29

  • iv Endoscopic ultrasound

    Clinical pathway.............................................................................................................29 Assessment framework ................................................................................................31 Review of the literature ................................................................................................31

    Gastric neoplasia.........................................................................................................................34 Research question .........................................................................................................34 Clinical pathway.............................................................................................................35 Assessment framework ................................................................................................37 Review of the literature ................................................................................................37

    Pancreatic neoplasia ...................................................................................................................39 Research question ............................