The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Combined endoscopic and laparoscopic removal of colonic polyps, in September 2014.
Colonic polyps are mucosal lesions that project into the lumen of the large bowel. Most colonic polyps cause no symptoms, but they may cause rectal bleeding, mucus in stools, abdominal pain and rarely diarrhoea or constipation. If left untreated, there is a small risk (approximately 1 in 10) that polyps may develop into bowel cancer after several years.
Colonic polyps are usually removed by an endoscopic snaring. Polyps that cannot be removed endoscopically are typically large, broad-based or situated in anatomically inaccessible areas (such as behind mucosal folds) where attempted endoscopic removal could result in bowel perforation. Polyps that are unsuitable for endoscopic removal need open or laparoscopic bowel resection.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
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.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
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.