Colonoscopy in octogenarians and older patients

Lagares‐Garcia, Jorge A.; Kurek, Stanley; Collier, Bryan R.; Díaz, F.; Schilli, Rudi; Richey, J.; Moore, Richard A.

doi:10.1007/s004640000339

Cited by 46 publications

(39 citation statements)

References 9 publications

(26 reference statements)

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“…Across all age groups, including those with advanced age, procedures were completed with similar procedural complications. Our observation confirms previous studies done in Western geriatric populations [9][10][11].…”

Section: Discussionsupporting

confidence: 93%

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Original article. Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand

et al. 2011

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Background: The use of sedation for gastrointestinal endoscopy (GIE) procedures in elderly patients has been established as a safe and effective technique. However, it is still uncertain whether the situation is valid for Asians.Objective: Evaluate the outcome of intravenous sedation (IVS) for GIE procedures in very elderly patients (>86 years old) in Thailand and compare the clinical efficacy of IVS between very elderly and those younger (<86 years old)Methods: We undertook a retrospective review of the sedation service records of patients who underwent GIE procedures between 2007 and 2008 at Siriraj Hospital, Thailand. All sedations were administered by anesthetic personnel in the endoscopy room. The cohort was divided into three groups, <65 years old (group 1), 65-85 years old (group 2), and >86 years old (group 3).Results: Sedation was provided for 1,779 patients (965, 687, and 127 patients in group 1, 2, and 3, respectively) in 2,061 GIE procedures. Fentanyl, midazolam and propofol were the most common IVS drugs used in all three groups. Patients in group 3 required lower mean doses of these intravenous sedatives than those in group 1 or 2 (p <0.001). Mean procedure time in group 3 was longer than in group 1 or 2 (p=0.010). Adverse events in group 3 occurred more frequently when compared to group 1 or 2 (p <0.001). Transient hypotension was the main complication across all aged groups.Conclusion: IVS for GIE procedure in very elderly patients was associated with higher minor advance events but relatively safe and effective when carried out by trained anesthetic personnel with appropriate monitoring and dose adjustment.

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Section: Discussionsupporting

confidence: 93%

“…This rate is similar to the rate of 1.4% reported by Clarke et al [9]. The rate of colonic perforation in the very elderly patient group was 0.8%, similar to the study by Lagares-Garcia et al [11].…”

Section: Discussionsupporting

confidence: 91%

Original article. Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand

et al. 2011

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“…While some experts are against sedation due to its potential adverse events and to the acceptable tolerance to endoscopic procedures by elderly patients (12,21), several studies support safety of sedation in the geriatric population (5,18,(22)(23)(24)(25)(26). Further, it has been recently published that detection rate of neoplastic lesions (its prevalence increases as we get older) is partially depended on the use of sedation(33) so necessity for sedation in endoscopic procedures is strengthened, specially in the geriatric population.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it has been proved that patients > 90 years present similar plasma propofol levels to younger controls although dose in older patients was 40% lower (18,20). Though this group of patients shows better tolerance to endoscopic procedures without sedation (18,21), several studies suggest that conscious and deep sedation are safe (5,18,(22)(23)(24)(25)(26). Moreover, some authors have suggested that the use of propofol by the endoscopy unit personnel may be efficient and safe even in elderly patients (5,(26)(27)(28)(29)(30), but the use of continuous propofol infusion in these group of patients is not reported.…”

Section: Introductionmentioning

confidence: 99%

Safety of continuous propofol sedation for endoscopic procedures in elderly patients

Martínez

Aparicio

Ruiz

et al. 2011

Rev. esp. enferm. dig.

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Objective: to evaluate safety of continuous propofol sedation in elderly patients who undergo endoscopic procedures and investigate risk factors to develop complications in the geriatric population.Material and methods: patients who received endoscopistdirected propofol sedation were classified into two groups according to age. Group I: > 80 years; Group II: < 80 years. Propofol was administered by continuous intravenous infusion to achieve deep sedation. Arterial oxygen saturation, heart rate, blood pressure, and electrocardiographic records were monitored during the procedure. Therapy and complications secondary to sedation were recorded.Results: one thousand two-hundred and ninety-five endoscopic procedures (gastroscopies, colonoscopies and endoscopic ultrasonographies) were included. The dose of propofol was lower and therapy was more frequently performed in Group I. There were no differences between sedation-related complications in both groups (Group I: 15.4%; Group II: 14%; p, NS). Patients in Group I showed greater tendency to develop severe oxygen desaturation in the colonoscopy and endoscopic ultrasonography procedures. In the univariate analysis, a higher dose of propofol was associated with the appearance of complications (157.4 ± 84.4 vs. 121.3 ± 89.6 mg) in elderly patients but it was not associated with severe oxygen desaturation.Conclusions: continuous propofol sedation during endoscopic procedures in elderly patients > 80 years is as safe as in younger patients.

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“…The most common indications for colonoscopy are gastrointestinal bleeding, anemia, changes in bowel habits and abdominal pain. Elderly patients are more likely to have abnormal colonoscopic findings than younger patients [110][111][112] . In fact, colorectal cancer, vascular and diverticular diseases are more common among the elderly [111,112] .…”

Section: Elderly Patientsmentioning

confidence: 99%

Achieving the best bowel preparation for colonoscopy

Parra‐Blanco¹,

Ruiz²,

Álvarez-Lobos³

et al. 2014

WJG

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Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here. Core tip: Bowel preparation for colonoscopy is a central issue related to the quality of the procedure. There are different agents for bowel preparation that can be administered with different schedules. We review the most commonly used agents, as well as new agents and combinations. Moreover, certain considerations should be taken into account for special populations in order to improve safety, efficacy and tolerance. Regimens for bowel preparation in special situations are discussed, such as for pedi...

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Colonoscopy in octogenarians and older patients

Abstract: Colonoscopy is safe in octogenarians and older patients. Age does not, by itself, confer an increased risk to the procedure.

Cited by 46 publications

References 9 publications

Original article. Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand

Original article. Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand

Safety of continuous propofol sedation for endoscopic procedures in elderly patients

Achieving the best bowel preparation for colonoscopy

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