NICE publishes the first directive on Colonoscopic monitoring of the colorectal cancer prevention in ulcerative colitis, Crohn's disease or adenoma patients

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Nice has published the first ever guidance on the monitoring of the colonoscopic [1] for the prevention of colorectal cancer in patients with ulcerative colitis [2], Crohn's disease [3] or adenomas [4]. Colonoscopic monitoring in people with inflammatory bowel disease (IBD, ulcerative colitis and Crohn's disease involves) or adenomas can detect, prevent colorectal cancer [5] problems at an early stage, and may.

Adults are IBD or adenomas higher risk of developing colorectal cancer than the general population. Colorectal cancer is the third most common cancer in the United Kingdom, with about 32,300 new cases diagnosed and 14,000 deaths in England and Wales each year. About half of people with colorectal cancer survive diagnosed for at least 5 years after diagnosis [6].

It is estimated that between 0.15 to 0.30% of the people in England and Wales ulcerative colitis or Crohn's disease. The risk of developing colorectal cancer for people with ulcerative colitis is estimated as 2% after 10 years to 20 years by 8% and 18% after 30 years of disease. The risk of developing colorectal cancer for people with Crohn's disease is for people with ulcerative colitis comparable.

The directive recommends that colonoscopic surveillance for people with IBD should be offered, whose symptoms began 10 years ago and have:

-Ulcerative colitis (but not proctitis [7] alone) or
-Morbus Crohn's Colitis [8] with more than a segment of the colon.

A baseline colonoscopy [9] should be offered with Chromoscopy [10] and a targeted biopsy of abnormal areas, to people with IBD, tested for colonoscopic surveillance to determine their risk of developing colorectal cancer. The directive also recommends that subsequent colonoscopic surveillance based colorectal cancer determined should be offered people with IBD to their risk of developing on their last full Colonoscopy:

-Low risk: offer colonoscopy with Chromoscopy at the age of five.

-Intermediate risk: offer colonoscopy with Chromoscopy at the age of three.

-High risk: colonoscopy with Chromoscopy to offer after a year.

A repeat colonoscopy should be offered with Chromoscopy, the Colonoscopy is incomplete. Colonoscopic monitoring should also for people, who had removed adenomas and are at low, medium or high risk of developing colorectal cancer are considered. The results of the adenoma removal should be used to determine people's risk of developing colorectal cancer and subsequent monitoring steps. A repeat colonoscopy should again be offered if it is incomplete, and consulting is an experienced Colonoscopist should also be considered. Calculated digital Kolonographie [11] (CTC) should be considered as a single test, when Colonoscopy is not clinically appropriate (for example, because of co-morbidity or because colonoscopy can not be tolerated). A double contrast barium enema [12] as a single test is recommended when a CTC is not available or not suitable. These two options should for the ongoing monitoring if a colonoscopy remains clinically inappropriate.

Said Dr. Judith Richardson, Associate Director, Center for clinical practice: "the evidence of the guideline development group as clearly indicates that colonoscopic surveillance in people with high risk of developing colorectal cancer early, and possibly prevent precancerous changes can detect progression to cancer." "These guidelines will help, make a real difference to the people of these serious diseases affected."

Professor Peter Howdle, Emeritus Professor St. James's University Hospital, Leeds, and guideline development group Chair said: "I was excited to participate in the development of this important guidelines, will complement the work already done in this area." It means that people with ulcerative colitis, Crohn's a Crohn's disease or adenomas services expect consistent determination can colonoscopic surveillance, which, as well as high-quality, are available when you need them. "I am confident that this will be in the prevention and early detection of colorectal cancer."

Professor Jon Rhodes, President, the British society of Gastroenterology, said: "there is currently some variations in the clinical practice of colonoscopic surveillance within the NHS, the British society of Gastroenterology welcome therefore these guidelines, the health professionals caring help the development of colorectal cancer in the primary and secondary for persons at high risk." "Be patient, I am sure, strong of these new guidelines will benefit."

Notes

Of the directive

-The guideline is available from Wednesday 23 March on the Nice website.

Related guidelines

-A previous NICE clinical directive on improving the results in colorectal cancer, (NICE cancer service guidance, 2004) is available here.

-Nizza interventional procedures guidance 101 (2004), to wireless capsule endoscopy examination of the small intestine is available here.

Guidelines in development

Nice developed the following related policies:

-Nizza clinical policy on the diagnosis and treatment of Dick and cancer. Expected to be released October 2011. For more information, here.

-Nizza clinical policy on the management of Crohn's disease. December 2012 expected to be released. For more information, here.

[1] Colonoscopic monitoring is carried out to check and detect abnormalities in the large intestine.

[2] Ulcerative colitis is a type of inflammatory bowel disease (IBD), affecting the lining of large intestine (colon) and rectum.

[3] Crohn's disease is a chronic inflammatory condition of unknown cause affecting a part of the gastrointestinal tract (gut).

[4] An adenoma is a benign tumor of glandular origin.

[5] Provides that bowel cancer screening programme screening test NHS faecal occult blood every 2 years for all men and women aged 60-74 years used for people who are not in this risk group. Generally, people in colonoscopic surveillance are not offered screening in the bowel cancer screening programme.

[6] NICE clinical guideline 118 on the colonoscopic surveillance.

[7] Proctitis is an inflammation of the anus and rectum.

[8]Crohn's colitis is an inflammation of the colon caused by Crohn's disease.

[9] Is a baseline colonoscopy a colonoscopic examination in which measurements are made (after a running-in phase if applicable). The results of the following Colonoscopies can be compared with the baseline colonoscopy.

[10] A Chromoscopy is the application of dyes on the surface of the mucous membrane lining mucous membrane improve irregularities.

[11] Digital Kolonographie (Virtual Colonoscopy) calculated. NICE interventional procedures guidance 129 (2005).

[12] Is a double contrast barium enema a series of X-rays of the colon and rectum are taken after the patient an Enema, followed by an injection of air is given. The barium outlines the bowels on X-rays, so that all abnormal growth be visible.

Source:
NICE