Colonoscopy in the very elderly: a review of 157 cases

Zerey, Marc; Paton, B. Lauren; Khan, Philip D.; Lincourt, Amy E.; Kercher, Kent W.; Greene, Frederick L.; Heniford, B. Todd

doi:10.1007/s00464-007-9269-x

Cited by 24 publications

(17 citation statements)

References 22 publications

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“…Three non-English papers were translated but only one met the inclusion criteria. We identified 62 eligible papers that provided relevant information separately for cancers and polyps [8,13-73]. Studies were published between 1960 and 2008.…”

Section: Resultsmentioning

confidence: 99%

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Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

et al. 2011

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BackgroundBowel symptoms are often considered an indication to perform colonoscopy to identify or rule out colorectal cancer or precancerous polyps. Investigation of bowel symptoms for this purpose is recommended by numerous clinical guidelines. However, the evidence for this practice is unclear. The objective of this study is to systematically review the evidence about the association between bowel symptoms and colorectal cancer or polyps.MethodsWe searched the literature extensively up to December 2008, using MEDLINE and EMBASE and following references. For inclusion in the review, papers from cross sectional, case control and cohort studies had to provide a 2×2 table of symptoms by diagnosis (colorectal cancer or polyps) or sufficient data from which that table could be constructed. The search procedure, quality appraisal, and data extraction was done twice, with disagreements resolved with another reviewer. Summary ROC analysis was used to assess the diagnostic performance of symptoms to detect colorectal cancer and polyps.ResultsColorectal cancer was associated with rectal bleeding (AUC 0.66; LR+ 1.9; LR- 0.7) and weight loss (AUC 0.67, LR+ 2.5, LR- 0.9). Neither of these symptoms was associated with the presence of polyps. There was no significant association of colorectal cancer or polyps with change in bowel habit, constipation, diarrhoea or abdominal pain. Neither the clinical setting (primary or specialist care) nor study type was associated with accuracy.Most studies had methodological flaws. There was no consistency in the way symptoms were elicited or interpreted in the studies.ConclusionsCurrent evidence suggests that the common practice of performing colonoscopies to identify cancers in people with bowel symptoms is warranted only for rectal bleeding and the general symptom of weight loss. Bodies preparing guidelines for clinicians and consumers to improve early detection of colorectal cancer need to take into account the limited value of symptoms.

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Section: Resultsmentioning

confidence: 99%

“…Forty papers provided information about the relationship between bleeding (of any type) and colorectal cancer [13-21,23-28,30,32,33,35,37,41,42,45-47,50,51,54-56,60-66,69,72,73], and 23 of these papers [13-17,20,21,23,24,26,28,30,33,41,42,46,47,54,56,61,63,72,73] also provided information about the relationship between bleeding and polyps.…”

Section: Resultsmentioning

confidence: 99%

Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

et al. 2011

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“…Studies from Asia have also reported higher risks of cardiovascular complications despite the fact that elderly patients on average received lower doses of sedatives [19] . Nevertheless, when taken in context, the complication rate is still quite low even for patients over 85 years of age, and in most cases colonoscopy can be done safely with appropriate monitoring and precautions [20] . Furthermore, several studies have shown that propofol sedation, despite its propensity to lower blood pressure, can be used safely in elderly patients [21][22][23] .…”

Section: Eventsmentioning

confidence: 99%

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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“…In this study, the very elderly had a 70% increased risk of complications compared to younger patients. Table 1 summarizes the complication rates of colonoscopy in the very elderly in studies performed during the past 10 years 16,17,18,26,27,28,29,30,31,32. The pooled complication rate of colonoscopy in the very elderly is 0-0.9%.…”

Section: Safety Of Colonoscopymentioning

confidence: 99%

Would You Recommend Screening Colonoscopy for the Very Elderly?

Myung

2014

Intest Res

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Life expectancy in Korea has increased, and the number of screening colonoscopies in the elderly has also dramatically increased. The net benefit of colonoscopy in the very elderly (≥80 years of age as defined by the World Health Organization) may be reduced because of the competing risk of mortality due to other diseases. Therefore, the decision to perform screening colonoscopy may be more complex in this age group. As the potential increase in life expectancy due to screening colonoscopy is significantly reduced in the very elderly, this procedure should be limited to those among the very elderly who have substantial life expectancies. Furthermore, considering the common major complications associated with colonoscopy, poor bowel preparation, and the possibility of incomplete colonoscopies in the very elderly, the performance of screening colonoscopy in the very elderly may not be an ideal recommendation. In terms of providing the greatest benefit to the most number of people, patients with the highest potential gain in terms of life expectancy, relative to the diagnostic yield, should be targeted for colonoscopy screening. This review addresses the unique considerations regarding screening colonoscopy in the very elderly and the individualized approach, which involves the weighing of the risks and benefits for each individual with consideration of their overall health status.

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Colonoscopy in the very elderly: a review of 157 cases

Abstract: Our data suggest that colonoscopy can be safely and successfully performed in the very elderly. In patients with symptoms or suggestive radiographic findings, cancer was detected in 4.0%-60% of cases. No cases of cancer were discovered in those patients who were asymptomatic.

Cited by 24 publications

References 22 publications

Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

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

Would You Recommend Screening Colonoscopy for the Very Elderly?

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