People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about 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.
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.
Offer colonoscopic surveillance to people with inflammatory bowel disease (IBD) whose symptoms started 10 years ago and who have:
ulcerative colitis (but not proctitis alone) or
Crohn's colitis involving more than one segment of colon.
Offer a baseline colonoscopy with chromoscopy and targeted biopsy of any abnormal areas to people with IBD who are being considered for colonoscopic surveillance to determine their risk of developing colorectal cancer (see box 1).
Box 1 Risk of developing colorectal cancer in people with IBD
Low risk:
extensive but quiescent ulcerative colitis or
extensive but quiescent Crohn's colitis or
left-sided ulcerative colitis (but not proctitis alone) or Crohn's colitis of a similar extent.
Intermediate risk:
extensive ulcerative or Crohn's colitis with mild active inflammation that has been confirmed endoscopically or histologically or
post-inflammatory polyps or
family history of colorectal cancer in a first-degree relative aged 50 years or over.
High risk:
extensive ulcerative or Crohn's colitis with moderate or severe active inflammation that has been confirmed endoscopically or histologically or
primary sclerosing cholangitis (including after liver transplant) or
colonic stricture in the past 5 years or
any grade of dysplasia in the past 5 years or
family history of colorectal cancer in a first-degree relative aged under 50 years.
Offer colonoscopic surveillance to people with IBD as defined in recommendation 1.1.1 based on their risk of developing colorectal cancer (see box 1), determined at the last complete colonoscopy:
Low risk: offer colonoscopy at 5 years.
Intermediate risk: offer colonoscopy at 3 years.
High risk: offer colonoscopy at 1 year.
For people with IBD who have been offered colonoscopic surveillance, continue to use colonoscopy with chromoscopy as the method of surveillance.
Offer a repeat colonoscopy with chromoscopy if any colonoscopy is incomplete. Consider whether a more experienced colonoscopist is needed.
Recommendation deleted. See the British Society of Gastroenterology's guidelines on post-polypectomy and post-colorectal cancer resection surveillance.
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Discuss the potential benefits, limitations and risks with people who are considering colonoscopic surveillance including:
early detection and prevention of colorectal cancer and
quality of life and psychological outcomes.
Inform people who have been offered colonoscopy, CTC, or barium enema about the procedure, including:
bowel preparation
impact on everyday activities
sedation
potential discomfort
risk of perforation and bleeding.
After receiving the results of each surveillance test, discuss the potential benefits, limitations and risks of ongoing surveillance. Base a decision to stop surveillance on potential benefits for the person, their preferences and any comorbidities. Make the decision jointly with the person, and if appropriate, their family or carers.
If there are any findings at surveillance that need treatment or referral, discuss the options with the person, and if appropriate, their family or carers.
Throughout the surveillance programme, give the person and their family or carers the opportunity to discuss any issues with a healthcare professional. Information should be provided in a variety of formats tailored to the person's needs and should include illustrations.