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Colonoscopic surveillance

Short Text

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

Introduction

This pathway covers colonoscopic surveillance to prevent colorectal cancer in people 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.
Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas. NICE clinical guideline 118 (2011)
Computed tomographic colonography (virtual colonoscopy). NICE interventional procedures guidance 129 (2005)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Assessment tools

The baseline and self-assessment tools are Excel spreadsheets that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.
Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas: baseline assessment

Audit support

Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas: audit support

Costing support

Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas: costing statement
Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas: costing template

Slide sets

Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas: slide set

Pathway information

Information for patients and the public

NICE produces booklets for patients and the public, called 'Understanding NICE guidance'. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written a booklet for patients and the public explaining its guidance on each of the following topics.
Colonoscopic surveillance
Colorectal cancer
Computed tomographic colonography (virtual colonoscopy)
Wireless capsule endoscopy for investigation of the small bowel
Improving outcomes in colorectal cancer
Referral guidelines for suspected cancer

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution – 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 someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent and the code of practice that accompanies the Mental Capacity Act. In Wales, healthcare professionals should follow advice on consent from the Welsh Government. If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children.

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.

Source guidance

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CG118

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 a booklet for patients and the public explaining the guidance on colonoscopic surveillance.

Source guidance

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CG118

Person with inflammatory bowel disease

View the 'Person with inflammatory bowel disease' path

Person with adenomas

View the 'Person with adenomas' path

Paths in this pathway

Pathway created: November 2011 Last updated: November 2011

Copyright © 2012 National Institute for Health and Clinical Excellence. All Rights Reserved.

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