Colonoscopy in the Elderly: Low Risk, Low Yield in Asymptomatic Patients

Duncan, James E.; Sweeney, W. Brian; Trudel, Judith L.; Madoff, Robert D.; Mellgren, Anders

doi:10.1007/s10350-005-0306-3

Cited by 57 publications

(65 citation statements)

References 16 publications

(11 reference statements)

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“…Arora et al [51] , 2004 110 80+ 97% 1 20% -Syn et al [9] , 2005 225 80+ 56% 11% 25% Yoong et al [52] , complication rate in patients over 80 is low, between 0.2% and 0.6% [11,15] , although it increased with specific comorbid conditions [24] . A large retrospective study reported an overall perforation rate of 0.082% for adults undergoing colonoscopy, with advanced age as a significant predictor [25] .…”

Section: +mentioning

confidence: 98%

“…Numerous studies have confirmed high yields for both screening and diagnostic colonoscopy in elderly patients ( Table 1). The reported yield of CRC in symptomatic elderly patients has ranged from 3.7% to 14.2% [9][10][11][12] . In a study on 200 symptomatic octogenarians, 80% had colonoscopic findings that explained their symptoms [13] .…”

Section: Yieldmentioning

confidence: 99%

“…June 16, 2014|Volume 6|Issue 6| WJGE|www.wjgnet.com C h a t r e n e t D u n c a n G e o r g e K a r a j e h L u k e n s M a S y n Figure 1 Published studies reporting rates of poor or inadequate bowel preparation for colonoscopy in elderly patients and non-elderly controls: Chatrenet [13] , Duncan [11] , George [53] , Karajeh [15] , Lukens [31] , Ma [19] and Syn [9] .…”

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confidence: 99%

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Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits

Lin

2014

WJGE

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Many diagnostic and screening colonoscopies are performed on very elderly patients. Although colonoscopic yield increases with age, the potential benefits in such patients decrease because of shorter life expectancy and more frequent comorbidities. Colonoscopy in very elderly patients carries a greater risk of complications and morbidity than in younger patients, and is associated with lower completion rates and higher likelihood of poor bowel preparation. Thus, screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks and patient preferences. On the other hand, diagnostic and therapeutic colonoscopy are more likely to benefit even very elderly patients, and in most cases should be performed if indicated.

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Section: +mentioning

confidence: 98%

Section: Yieldmentioning

confidence: 99%

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confidence: 99%

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Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits

Lin

2014

WJGE

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“…It has also been seen that colonoscopy yields a noninfectious diagnosis more oft en than upper endoscopy (170)(171)(172). A review of 18 primary studies looking at the diagnostic value of colonoscopy in patients with chronic diarrhea, as well as a review of nine published guidelines provides the basis for a colonoscopy recommendation in such patients ( 165,167,168,(173)(174)(175)(176)(177)(178)(179)(180)(181)(182)(183)(184)(185)(186).…”

Section: Th E Evidence Does Not Support Empiric Anti-microbial Therapymentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

Riddle

DuPont

Connor

2016

American Journal of Gastroenterology

316

250

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Acute diarrheal infections are a common health problem globally and among both individuals in the United States and traveling to developing world countries. Multiple modalities including antibiotic and non-antibiotic therapies have been used to address these common infections. Information on treatment, prevention, diagnostics, and the consequences of acute diarrhea infection has emerged and helps to inform clinical management. In this ACG Clinical Guideline, the authors present an evidence-based approach to diagnosis, prevention, and treatment of acute diarrhea infection in both US-based and travel settings. Am J Gastroenterol 2016; 111:602-622; doi: 10.1038/ajg.2016 A follow-up survey where 3,568 respondents (median age 51) were asked at random about illness in the previous 7 days or previous month found that recall bias had an important eff ect on estimates of acute gastrointestinal illness ( 10 ). Using a 7-day exposure window, the estimated incidence of acute diarrhea was 1.6 episodes per person-year, compared with 0.9 episodes per person-year if asked about illness within the preceding month. Other population-based studies from Canada and western European countries using varied methodologies estimate annual incidence between 0.1 to 3.5 episodes per person-year ( 11 18. Antibiotic chemoprophylaxis has moderate to good effectiveness and may be considered in high-risk groups for short-term use. (Strong recommendation, high level of evidence) TD, traveler's diarrhea.

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“…In fact, colorectal cancer, vascular and diverticular diseases are more common among the elderly [111,112] . Even though the prevalence of neoplastic lesions increases with age, the diagnostic yield of a screening colonoscopy among the elderly (aged ≥ 80 years), who have a short life expectancy, is low [113] . This indicates the limits of screening procedures.…”

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 the Elderly: Low Risk, Low Yield in Asymptomatic Patients

Cited by 57 publications

References 16 publications

Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits

Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits

ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

Achieving the best bowel preparation for colonoscopy

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