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Gastrointestinal conditions

About

What is covered

This interactive flowchart includes recommendations on gastrointestinal conditions, including conditions of the oesophagus, stomach, small intestine, gallbladder, pancreas, large intestine, rectum and anus.

Updates

Updates to this interactive flowchart

22 August 2017 Radiofrequency treatment for haemorrhoids (NICE interventional procedures guidance 589) added to haemorrhoids and anal fissure.
23 May 2017 Endoscopic full thickness removal of non-lifting colonic polyps (NICE interventional procedures guidance 580) added to colostomy and other colon surgery.
25 April 2017 Obeticholic acid for treating primary biliary cholangitis (NICE technology appraisal guidance 443) added to primary biliary cholangitis.
10 January 2017 Integrated multiplex PCR tests for identifying gastrointestinal pathogens in people with suspected gastroenteritis (xTAG Gastrointestinal Pathogen Panel, FilmArray GI Panel and Faecal Pathogens B assay) (NICE diagnostics guidance 26) added to stomach conditions, small intestine, gallbladder and pancreas conditions and large intestine conditions.
22 November 2016 Endoscopic transluminal pancreatic necrosectomy (NICE interventional procedures guidance 567) added to pancreatitis and pancreatic cysts.
6 April 2016 Added:
28 October 2015 Added:
  • flexible endoscopic treatment of a pharyngeal pouch (NICE interventional procedures guidance 513)
  • subcutaneous implantation of a battery-powered catheter drainage system for managing refractory and recurrent ascites (NICE interventional procedures guidance 479)
  • complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique) (NICE interventional procedures guidance 56)
  • endoscopic stapling of pharyngeal pouch (NICE interventional procedures guidance 22).
23 June 2015 Electrotherapy for the treatment of haemorrhoids (NICE interventional procedures guidance 525) added.
2 June 2015 Radiofrequency ablation for gastric antral vascular ectasia (NICE interventional procedures guidance 520) added.
16 December 2014 Insertion of a collagen plug to close an abdominal wall enterocutaneous fistula (NICE interventional procedures guidance 507) added.
23 September 2014 Added:
  • combined endoscopic and laparoscopic removal of colonic polyps (NICE interventional procedures guidance 503)
  • assessing motility of the gastrointestinal tract using a wireless capsule (NICE interventional procedures guidance 502).
22 July 2014 Endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus (NICE interventional procedures guidance 497) added.
27 May 2014 Gastroelectrical stimulation for gastroparesis (NICE interventional procedures guidance 489) added.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on gastrointestinal conditions in an interactive flowchart

What is covered

This interactive flowchart includes recommendations on gastrointestinal conditions, including conditions of the oesophagus, stomach, small intestine, gallbladder, pancreas, large intestine, rectum and anus.

Updates

Updates to this interactive flowchart

22 August 2017 Radiofrequency treatment for haemorrhoids (NICE interventional procedures guidance 589) added to haemorrhoids and anal fissure.
23 May 2017 Endoscopic full thickness removal of non-lifting colonic polyps (NICE interventional procedures guidance 580) added to colostomy and other colon surgery.
25 April 2017 Obeticholic acid for treating primary biliary cholangitis (NICE technology appraisal guidance 443) added to primary biliary cholangitis.
10 January 2017 Integrated multiplex PCR tests for identifying gastrointestinal pathogens in people with suspected gastroenteritis (xTAG Gastrointestinal Pathogen Panel, FilmArray GI Panel and Faecal Pathogens B assay) (NICE diagnostics guidance 26) added to stomach conditions, small intestine, gallbladder and pancreas conditions and large intestine conditions.
22 November 2016 Endoscopic transluminal pancreatic necrosectomy (NICE interventional procedures guidance 567) added to pancreatitis and pancreatic cysts.
6 April 2016 Added:
28 October 2015 Added:
  • flexible endoscopic treatment of a pharyngeal pouch (NICE interventional procedures guidance 513)
  • subcutaneous implantation of a battery-powered catheter drainage system for managing refractory and recurrent ascites (NICE interventional procedures guidance 479)
  • complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique) (NICE interventional procedures guidance 56)
  • endoscopic stapling of pharyngeal pouch (NICE interventional procedures guidance 22).
23 June 2015 Electrotherapy for the treatment of haemorrhoids (NICE interventional procedures guidance 525) added.
2 June 2015 Radiofrequency ablation for gastric antral vascular ectasia (NICE interventional procedures guidance 520) added.
16 December 2014 Insertion of a collagen plug to close an abdominal wall enterocutaneous fistula (NICE interventional procedures guidance 507) added.
23 September 2014 Added:
  • combined endoscopic and laparoscopic removal of colonic polyps (NICE interventional procedures guidance 503)
  • assessing motility of the gastrointestinal tract using a wireless capsule (NICE interventional procedures guidance 502).
22 July 2014 Endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus (NICE interventional procedures guidance 497) added.
27 May 2014 Gastroelectrical stimulation for gastroparesis (NICE interventional procedures guidance 489) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Obeticholic acid for treating primary biliary cholangitis (2017) NICE technology appraisal guidance 443
Stapled haemorrhoidopexy for the treatment of haemorrhoids (2007) NICE technology appraisal guidance 128
Laparoscopic surgery for inguinal hernia repair (2004) NICE technology appraisal guidance 83
Radiofrequency treatment for haemorrhoids (2017) NICE interventional procedures guidance 589
Endoscopic full thickness removal of non-lifting colonic polyps (2017) NICE interventional procedures guidance 580
Endoscopic transluminal pancreatic necrosectomy (2016) NICE interventional procedures guidance 567
Electrotherapy for the treatment of haemorrhoids (2015) NICE interventional procedures guidance 525
Radiofrequency ablation for gastric antral vascular ectasia (2015) NICE interventional procedures guidance 520
Flexible endoscopic treatment of a pharyngeal pouch (2015) NICE interventional procedures guidance 513
Combined endoscopic and laparoscopic removal of colonic polyps (2014) NICE interventional procedures guidance 503
Assessing motility of the gastrointestinal tract using a wireless capsule (2014) NICE interventional procedures guidance 502
Endoscopic radiofrequency ablation for squamous dysplasia of the oesophagus (2014) NICE interventional procedures guidance 497
Gastroelectrical stimulation for gastroparesis (2014) NICE interventional procedures guidance 489
Faecal microbiota transplant for recurrent Clostridium difficile infection (2014) NICE interventional procedures guidance 485
Closure of anal fistula using a suturable bioprosthetic plug (2011) NICE interventional procedures guidance 410
Percutaneous retroperitoneal endoscopic necrosectomy (2011) NICE interventional procedures guidance 384
Stapled transanal rectal resection for obstructed defaecation syndrome (2010) NICE interventional procedures guidance 351
Haemorrhoidal artery ligation (2010) NICE interventional procedures guidance 342
Percutaneous endoscopic colostomy (2006) NICE interventional procedures guidance 161
Foker technique for long-gap oesophageal atresia (2006) NICE interventional procedures guidance 153
Wireless capsule endoscopy for investigation of the small bowel (2004) NICE interventional procedures guidance 101
Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique) (2004) NICE interventional procedures guidance 56
Circular stapled haemorrhoidectomy (2003) NICE interventional procedures guidance 34
Laparo-endogastric surgery (2003) NICE interventional procedures guidance 25
Endoscopic stapling of pharyngeal pouch (2003) NICE interventional procedures guidance 22
Clostridium difficile infection: fidaxomicin (2012) NICE evidence summary ESNM1
Chronic anal fissure: botulinum toxin type A injection (2013) NICE evidence summary ESUOM14
Permacol for treating anal fistulae (2017) NICE medtech innovation briefing 105
NaviCam for diagnosing gastrointestinal tract conditions (2017) NICE medtech innovation briefing 104
VAAFT for treating anal fistulae (2017) NICE medtech innovation briefing 102
Ultroid 2.0 for internal haemorrhoids (2016) NICE medtech innovation briefing 75

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

NICE has published interventional procedures guidance on insertion of a collagen plug to close an abdominal wall enterocutaneous fistula with special arrangements for clinical governance, consent and audit or research.
NICE has published a clinical knowledge summary on gastroenteritis. This practical resource is for primary care professionals (it is not formal NICE guidance).

Integrated multiplex PCR tests for identifying gastrointestinal pathogens

There is currently insufficient evidence to recommend the routine adoption in the NHS of the integrated multiplex polymerase chain reaction tests, xTAG Gastrointestinal Pathogen Panel, FilmArray GI Panel and Faecal Pathogens B assay, for identifying gastrointestinal pathogens in people with suspected gastroenteritis.
The tests show promise but further research is recommended on their effect on health outcomes and resource use in clinical practice (see section 6 of NICE diagnostics guidance 26).

Medtech innovation briefings

NICE has published medtech innovation briefings on:

Glossary

transabdominal preperitoneal procedure
totally extraperitoneal procedure

Paths in this pathway

Pathway created: November 2013 Last updated: August 2017

© NICE 2017. All rights reserved. Subject to Notice of rights.

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