Technical / NICE: Chromoendoscopy enables real-time polyp assessment

NICE has recommended the use of virtual chromoendoscopy using narrow band imaging (NBI), flexible spectral imaging colour enhancement (FICE) or iscan to assess polyps of 5mm or less during colonoscopy under set conditions, writes Nicola Bodey. This can be used to determine whether they are adenomatous or hyperplastic.

Colorectal polyps are small growths on the inner lining of the colon that carry a small risk of becoming cancerous. They affect 15% to 20% of the UK population. Colorectal cancer is the second most common cause of cancer death in the UK – there are about 40,000 new cases registered each year. 

Current clinical practice is to remove all polyps found during colonoscopy investigations and send them to laboratory services for histopathology assessment. Polyps are examined to determine whether they are adenomatous (and so at high risk of cancer) or hyperplastic (at low risk). 

Virtual chromoendoscopy technologies allow colour-enhanced visualisation of blood vessels and surface pattern. They may allow real-time differentiation of adenomas and hyperplastic colorectal polyps during colonoscopy. This could lead to fewer unnecessary resections of low-risk polyps, quicker results and management decisions, and reduce use of histopathology examinations. 

It is estimated that 410 people per 100,000 population are eligible for assessment with virtual chromoendoscopy each year. From year five, it is estimated that 330 people for every 100,000 population will have an assessment with virtual chromoendoscopy each year once uptake has reached 80%.

The guidance is expected to lead to a cost saving for the NHS and may improve patient experience. The saving depends on avoiding unnecessary histopathology assessments when assessing colorectal polyps. The annual saving associated with implementing the guidance for every 100,000 population is estimated to be £3,800 in year one, increasing to £18,800 from year five. This equates to a £10.3m saving in England from year five.

The use of virtual chromoendoscopy technologies is commissioned by clinical commissioning groups (CCGs). Providers are NHS hospital trusts.