Quality statement 1: Colonoscopy
People with suspected colorectal cancer without major comorbidity are offered diagnostic colonoscopy.
Structure: Evidence of local arrangements to ensure people with suspected colorectal cancer without major comorbidity are offered diagnostic colonoscopy.
Process: Proportion of people with suspected colorectal cancer without major comorbidity who receive diagnostic colonoscopy.
Numerator – the number of people in the denominator who receive diagnostic colonoscopy.
Denominator – the number of people with suspected colorectal cancer without major comorbidity.
Service providers ensure systems are in place for people with suspected colorectal cancer without major comorbidity to be offered diagnostic colonoscopy.
Healthcare professionals ensure they offer diagnostic colonoscopy to people with suspected colorectal cancer without major comorbidity.
Commissioners ensure they commission services for people with suspected colorectal cancer without major comorbidity that offer diagnostic colonoscopy.
People with suspected colorectal cancer without any other significant diseases are offered a procedure called colonoscopy, which allows the large bowel to be viewed through a camera on the end of a flexible tube, to establish the diagnosis.
NICE clinical guideline 131 recommendations 126.96.36.199 (key priority for implementation) and 188.8.131.52.
Structure: Local data collection.
Process: Local data collection. The National Bowel Cancer Audit records colonoscopy results, classified as abnormal (cancer detected whether complete examination or not), inadequate (no cancer detected but incomplete examination), not done or not known. The NHS Bowel Cancer Screening Programme's Quality assurance guidelines for colonoscopy suggest indicators based on data returns, including:
minimum number of screening colonoscopies
response rate (acceptance rate) for colonoscopy (index and surveillance)
surveillance colonoscopy attendance rate
safe sedation and comfort
caecal intubation rate
neoplasia detection rates
withdrawal time in negative colonoscopies
Also contained within NICE audit support for colorectal cancer (NICE clinical guideline 131): Diagnosis, criteria 1 and 2.
NICE clinical guideline 131 (full version) concludes that colonoscopy is the most effective investigation for diagnosis of colorectal tumours. It also allows immediate biopsy confirmation of colorectal cancer and removal of adenomas during the same procedure. Therefore, the guideline recommends colonoscopy as the first investigation for the diagnosis of colorectal tumours.
NICE clinical guideline 131 (full version) recognises it may not be possible to perform complete colonoscopy in some patients. Also, patients with serious cardiorespiratory or neurological comorbidity may be at high risk from potential complications of colonoscopy (for example colonic perforation or the effects of sedation). Such patients might be better served by alternative investigations.