Overview

This guideline covers using colonoscopy to check for signs of bowel cancer in people aged 18 and over with ulcerative colitis or Crohn’s disease (types of inflammatory bowel disease) or adenomas (also known as polyps). It aims to prevent cancer and prolong life by offering advice on identifying early bowel cancer in adults most at risk.

Introduction

Adults with inflammatory bowel disease (IBD, which covers ulcerative colitis and Crohn’s disease) or with adenomas have a higher risk of developing colorectal cancer than the general population. Colorectal cancer is the third most common cancer in the UK, with approximately 32,300 new cases diagnosed and 14,000 deaths in England and Wales each year. Around half of the people diagnosed with colorectal cancer survive for at least 5 years after diagnosis.

The prevalence of ulcerative colitis is approximately 100 to 200 per 100,000 and the annual incidence is 10 to 20 per 100,000. The risk of developing colorectal cancer for people with ulcerative colitis is estimated as 2% after 10 years, 8% after 20 years and 18% after 30 years of disease.

The prevalence of Crohn’s disease is approximately 50 to 100 per 100,000 and the annual incidence is 5 to 10 per 100,000. The risk of developing colorectal cancer for people with Crohn’s disease is considered to be similar to that for people with ulcerative colitis with the same extent of colonic involvement.

Colonoscopic surveillance in people with IBD or adenomas can detect any problems early and potentially prevent progression to colorectal cancer. For people who are not in these high-risk groups, the NHS Bowel Cancer Screening Programme offers screening using faecal occult blood testing every 2 years to all men and women aged 60 to 74 years. People undergoing colonoscopic surveillance are not generally offered screening as part of the Bowel Cancer Screening programme.

The British Society of Gastroenterology (BSG) issued guidelines for colonoscopic surveillance for people who have had adenomas removed and for people with IBD (Atkin and Saunders 2002; Eaden and Mayberry 2002; updated by Cairns et al. 2010). NICE has developed this short clinical guideline on the use of colonoscopic surveillance because of variations in clinical practice. Some members of the NICE Guideline Development Group (GDG) were also members of the group that developed the BSG guidelines. The evidence-based recommendations and algorithms developed in the NICE guideline are broadly consistent with those in the 2010 BSG guidelines. Both guidelines used a similar evidence base, with the exception of health economics evidence, which was not considered for the BSG guidelines. However, there are some differences between the two guidelines because the processes and methods used to develop each guideline were different.

Throughout this guideline, the term ‘adenomas’ is used. However, other terms have been used in the clinical studies included in the evidence review, for example ‘polyps’ or ‘adenomatous polyps’.

Recommendations

The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop the guidance.

Recommendations for research

We have made the following recommendations for research, based on our review of the evidence, to improve NICE guidance and patient care in the future.

Finding more information and committee details

To find NICE guidance on related topics, including guidance in development, see the NICE topic page on colorectal cancer.

For full details of the evidence and the guideline committee’s discussions, see the full guideline. You can also find information about how the guideline was developed, including details of the committee.

NICE has produced tools and resources to help you put this guideline into practice. For general help and advice on putting our guidelines into practice, see resources to help you put NICE guidance into practice.

Update information

September 2022: We have replaced recommendations 1.1.6 to 1.1.13 on colonoscopy for adults with adenomas with a link to the British Society of Gastroenterology’s guidelines on post-polypectomy and post-colorectal cancer resection surveillance.

Your responsibility: 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.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

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.