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SHTAC is critically evaluating the clinical effectiveness and cost-effectiveness of virtual chromoendoscopy for the real-time assessment of colorectal polyps

Published: 23 August 2016
Colonoscopy
Around one in five people in the UK get bowel polyps

A systematic review and economic evaluation of virtual chromoendoscopy will inform guidance from the National Institute for Health and Care Excellence (NICE) Diagnostics Assessment Programme, due in early 2017

Colorectal polyps are growths that can develop in the large bowel. Around one in five people in the UK get bowel polyps. Most are not cancerous, but some types, called adenomas, can become cancerous if not diagnosed and removed. Currently, specialised doctors or nurses, called ‘endoscopists’, use colonoscopy to detect polyps. The endoscopist inserts a flexible tube with a camera on it into the bowel. If a polyp is found, it is removed and sent to a laboratory to examine if it is an adenoma. In some patients, polyp removal can cause bleeding or a bowel perforation. Some patients also experience anxiety waiting for the laboratory result.

New colonoscopy techniques, called virtual chromoendoscopy, have been developed for diagnosing polyps. Endoscopists can use these techniques to decide in real-time which polyps are adenomas without sending them to a laboratory. The endoscopist could then decide whether to remove the polyp or, if confident that it is not an adenoma, leave it in the colon. This could reduce risks of bleeding or bowel perforation. This strategy could also reduce patients’ anxiety, as they would receive results immediately. It may also save the NHS money through reducing laboratory costs, and outpatient appointments. There is, however, uncertainty about how effective this approach is and if it would be an effective use of NHS financial resources (that is, cost-effective).

For the NICE Diagnostics Assessment Programme SHTAC is conducting a systematic review and economic evaluation of the clinical accuracy and cost-effectiveness of three virtual chromoendoscopy technologies: Flexible Spectral Imaging Colour Enhancement (FICE) (Aquilant Endoscopy/FujiFilm); i-scan (Pentax Medical) and Narrow band imaging (Olympus Medical Systems). NICE is expected to issue guidance to the NHS in February 2017. The full assessment report will be available open access in the NIHR Journals Library in early 2017.

For more information on SHTAC’s research into diagnostic technologies please visit our Research page.

 

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