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Virtual chromoendoscopy for the diagnosis of diminutive colorectal polyps is recommended by NICE, informed by a SHTAC report

Published: 18 May 2017
Colonoscopy
Around one in five people in the UK get bowel polyps

New guidance is available from the National Institute for Health and Clinical Excellence on the use of virtual chromoendoscopy for diagnosis of diminutive colorectal polyps, based on a systematic review and economic evaluation conducted by SHTAC.

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 (a process known as histopathology) and an appropriate surveillance interval is then set. 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 histopathology, as has traditionally been done. The endoscopist can 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 associated with removal. 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, considered cost-effective).

SHTAC conducted a systematic review and economic evaluation of the clinical effectiveness and cost-effectiveness of three virtual chromoendoscopy technologies for diagnosing diminutive (5mm in size or less) polyps for the National Institute for Health and Clinical Excellence (NICE) Diagnostics Assessment Programme. The technologies were: Flexible Spectral Imaging Colour Enhancement (FICE) (Aquilant Endoscopy/FujiFilm); i-scan (Pentax Medical) and Narrow Band Imaging (NBI) (Olympus Medical Systems). 

NICE’s guidance to the National Health Service is that virtual chromoendoscopy using NBI, FICE or i‑scan is recommended to assess polyps of 5 mm in size or less during colonoscopy, instead of histopathology, to determine whether they are adenomatous. The following conditions must apply: high-definition enabled virtual chromoendoscopy equipment is used; the endoscopist has been trained to use virtual chromoendoscopy, and accredited to use the technique under a national accreditation scheme; the endoscopy service includes systems to audit endoscopists and provide ongoing feedback on their performance and the assessment is made with a high confidence judgement by the endoscopist.

The full SHTAC assessment report will be available open access in the NIHR Journals Library in October 2017.

For further information on SHTAC’s published research into cancer and into diagnostic technologies for other conditions please see our research page.

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