Colonoscopy in the very old: why bother?

Abstract

Objectives To evaluate the use of colonoscopy in patients aged at least 85 years. Does the ideal of an ageism free service apply? Design A retrospective audit. Setting Department of gastroenterology that carries out about 1000 colonoscopies annually in a district general hospital serving a population of about 320 000. Subjects All patients aged at least 85 years who underwent colonoscopy over five years to 2003. Main outcome measures The indications for colonoscopy and its findings. The outcome of patients found to have colonic cancers. Results Colonoscopy was completed in 219 cases (69%). The main reasons for failure were poor bowel preparation and severe diverticular disease. Normal findings occurred in 65 (30%) of the 219 cases that had had a complete examination. Colonoscopy identified a problem that explained the patient’s symptoms in 116 (37%) cases. Polyps were found in 45 (14.2%) cases and malignancy in 28 (8.8%). Conclusions The absence of significant complications and comparatively high yield of colonic malignancies and polyps reinforces the value of colonoscopy as a diagnostic tool even after 85 years of age and despite the technical challenges of the procedure in this age group that limited completion. Increasing age alone should not preclude a patient from colonoscopy.

Risks and Benefits of Colonoscopy in Patients 90 Years or Older, Compared With Younger Patients

“…Previous studies have mostly focused on octogenarians, with a meta-analysis showing that the colonoscopy completion rate was 84.7% for patients !80 years old. 10 For those older than 85 years, a retrospective study reported only a 69% completion rate, mostly because of poor bowel preparation and severe diverticular disease, 14 whereas a prospective study comparing octogenarians and non-octogenarians also showed a lower completion rate in the former, again mostly attributed to preparation quality. 6 In fact, inadequate bowel preparation was a major factor in many studies that demonstrated lower colonoscopy completion rates in VE patients.…”

“…7,14,[19][20][21][22][23] The reported prevalence of CRC in octogenarians undergoing colonoscopy has ranged from 3.7% to 14.2%. [19][20][21][22] In terms of diagnostic yield for advanced neoplasia, reported values varied from 50.9% in a small prospective study (n ¼ 110) 9 to 13.0% in a large retrospective study (n ¼ 1112).…”

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

“…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] .…”

Elektif Kolonoskopi Öncesi Uygulanan Kolon Hazırlığı Talimatlarına Hastaların Uyumu; Anket Çalışması

“…Sodyum fosfat ile yapılan kolon hazırlığının etkinliği değerlendirildiğinde, barsak hazırlığı yapılan hastaların %78-%98 oranında yeterli barsak hazırlığı sağlandığı gösteren çalışmalar mevcuttur. (9)(10)(11)(12)(13)(14)(15)(16)(17) Bizim çalışmamızda ise tüm grupta hastaların %97'sinde yeterli kolon hazırlığı sağlanmıştır.…”