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Colonoscopic surveillance

Short Text

Colonoscopic surveillance for the prevention of colorectal cancer in adults with ulcerative colitis, Crohn's disease or adenomas

Introduction

This pathway covers colonoscopic surveillance to prevent colorectal cancer in adults with ulcerative colitis, Crohn's disease or adenomas.
Some people with inflammatory bowel disease (ulcerative colitis or Crohn's disease) or with adenomas have a higher risk of developing colorectal cancer than the general population.
In this pathway 'adenomas' is used to refer to precancerous polyps. Adenomas larger than 10 mm are more likely to progress to invasive cancers.
Colonoscopic surveillance can identify precancerous lesions early and prevent progression to colorectal cancer. It can also identify invasive cancer at an early stage. The aim of this guideline is to reduce the variation in the timing, frequency and method of surveillance to improve the care of people with inflammatory bowel disease or adenomas at increased risk of developing colorectal cancer.

Source guidance

The NICE guidance that was used to create the pathway.
Computed tomographic colonography (virtual colonoscopy). NICE interventional procedures guidance 129 (2005)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

2 January 2014 Minor maintenance updates.
5 February 2013 Minor maintenance updates.

Supporting information

Risk of developing colorectal cancer in people with adenomas

Low risk: one or two adenomas smaller than 10 mm.
Intermediate risk: three or four adenomas smaller than 10 mm or one or two adenomas if one is 10 mm or larger.
High risk: five or more adenomas smaller than 10 mm or three or more adenomas if one is 10 mm or larger.

Glossary

Person at higher than average risk of colorectal cancer because of inflammatory bowel disease or adenomas

Person at higher than average risk of colorectal cancer because of inflammatory bowel disease or adenomas

Person at higher than average risk of colorectal cancer because of inflammatory bowel disease or adenomas

In this pathway inflammatory bowel disease refers to ulcerative colitis or Crohn's disease. 'Adenomas' is used to refer to precancerous polyps.
NICE has produced pathways on:

Source guidance

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Information and support

Information and support

Information and support

Give the person and their family or carers the opportunity to discuss their concerns at any time.
Discuss the potential benefits, limitations and risks with people considering colonoscopic surveillance, including:
  • early detection and prevention of colorectal cancer
  • quality of life and psychological outcomes.
Inform people about the procedures offered, including:
  • bowel preparation
  • impact on everyday activities
  • sedation
  • potential discomfort
  • risk of perforation and bleeding.
After receiving the results of each surveillance test, discuss the potential benefits, limitations and risks of ongoing surveillance.
Make a decision to stop surveillance jointly with the person, and if appropriate, with their family or carers, based on the potential benefits for the person, their preferences and comorbidities.
If any findings at surveillance need treatment or referral, discuss the options with the person, and if appropriate, with their family or carers.
Information should be provided in a variety of formats tailored to the person's needs and should include illustrations.
NICE has written information for the public explaining the guidance on colonoscopic surveillance.

Source guidance

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Person with inflammatory bowel disease

View the 'Person with inflammatory bowel disease' path

Patient experience in adult NHS services pathway

View the 'Patient experience in adult NHS services overview' path

Paths in this pathway

Pathway created: November 2011 Last updated: January 2014

Copyright © 2014 National Institute for Health and Care Excellence. All Rights Reserved.

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