Endoscopy in the Elderly

Razavi, Farid; Gross, Seth A.; Katz, Seymour

doi:10.1016/j.cger.2013.10.010

Cited by 20 publications

(9 citation statements)

References 81 publications

(88 reference statements)

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“…Surprisingly despite similar hemorrhage rates, individuals ≥ 85 were much less likely to receive related endoscopic procedures (p = 0.005). Although the specific reasons for not performing endoscopic procedures were unknown, there is an increased risk of complications, often due to the bowel preparation or anesthetics, with advancing age and frailty [31]. The hemorrhagic risk appears to be similar based on dialysis modalities with the only difference detected being in gastrointestinal endoscopic procedures.…”

Section: Discussionmentioning

confidence: 99%

The Three-Year Incidence of Major Hemorrhage among Older Adults Initiating Chronic Dialysis

Sood

Bota

McArthur

et al. 2014

Can J Kidney Health Dis

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BackgroundFor those who initiate chronic dialysis, knowing what proportion will experience 3-year outcomes of hemorrhage with hospitalization informs patient prognosis, disease impact, and the planning of trials and programs to prevent events.ObjectivesWe examined the incidence of hemorrhage and related gastrointestinal endoscopic procedures in incident older dialysis patients and stratified patients by age, era, dialysis modality and whether recently prescribed anti-thrombotic medication.DesignRetrospective cohort studySettingOntario, Canada from 1998 to 2008 (n = 11,173)PatientsAll older patients (>65 years) who initiated chronic dialysisMeasurementsHospitalization with hemorrhage and its subtypes (upper and lower gastrointestinal, intra-cerebral, subarachnoid) and related-gastrointestinal procedures.MethodsThree-year outcomes of hospitalization with hemorrhage were expressed as cumulative incidence and incidence rate (number of events per 1,000 patient years). Results were stratified by patient age (66 to 74, 75 to 84, ≥ 85), era (1998 to 2001, 2002 to 2005, 2006 to 2008) and dialysis modality. Among those with hemorrhage, we examined prescriptions for anti-thrombotic medications (warfarin, clopidogrel) in the preceding 120 days.ResultsThe 3-year cumulative incidence of hemorrhage was 14.4% (roughly 1 in 7 patients). By location, the 3-year cumulative incidence was 8.9% lower gastrointestinal, 6.1% upper gastrointestinal, 0.9% intra-cerebral and 0.1% sub arachnoid hemorrhage. The 3-year cumulative incidence of gastrointestinal endoscopic procedures was 14.8%. The cumulative incidence and rate of hemorrhage were not appreciably different across the 3 age strata, by era or by dialysis modality. Among patients with a hemorrhage, 29.5% were prescribed warfarin in the preceding 120 days, and 8.4% clopidogrel.LimitationsRecurrent events were not included.ConclusionsMany older patients who initiate chronic dialysis will be hospitalized with hemorrhage and receive related procedures over the subsequent three years. Despite greater age and co-morbidity over the last decade this incidence has not changed.Electronic supplementary materialThe online version of this article (doi:10.1186/s40697-014-0021-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The Three-Year Incidence of Major Hemorrhage among Older Adults Initiating Chronic Dialysis

Sood

Bota

McArthur

et al. 2014

Can J Kidney Health Dis

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“…As global aging increases and a growing need for GI endoscopy in elderly patients becomes increasingly inevitable in the real world, the safety of GI endoscopy in elderly patients is an ongoing concern for physicians. 24 - 27 Therefore, our study is unique in that the safety of EGD, colonoscopy, and colonoscopic polypectomy is reported with respect to both GI and non-GI complications using a population-based database from Asia.…”

Section: Discussionmentioning

confidence: 99%

“…EGD is generally known to be safe and well-tolerated in the elderly; 22 , 25 - 28 however, its risk is largely related to comorbidity and sedation during the procedure. To our knowledge, there has been no population-based study performed to evaluate GI and non-GI complications after EGD in the elderly population.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal and Nongastrointestinal Complications of Esophagogastroduodenoscopy and Colonoscopy in the Real World: A Nationwide Standard Cohort Using the Common Data Model Database

et al. 2021

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Background/Aims: The global trend of an expanding aged population has increased concerns about complications correlated with gastrointestinal (GI) endoscopy in elderly patients; however, there have been few reports published on this issue. Methods:In this retrospective, observational cohort study performed between 2012 and 2017, serious complications of esophagogastroduodenoscopy (EGD), colonoscopy, and colonoscopic polypectomy were compared between patients according to age (≥65 years vs 18-64 years). We used the Health Insurance Review and Assessment-National Patient Samples database, previously converted to the standardized Observational Medical Outcomes Partnership-Common Data Model. Serious complications within 30 days of the procedure included both GI complications (bleeding and perforation) and non-GI complications (cerebrovascular accident [CVA], acute myocardial infarction [AMI], congestive heart failure [CHF], and death).Results: A total of 387,647 patients who underwent EGD, 241,094 who underwent colonoscopy, and 89,059 who underwent colonoscopic polypectomy were assessed as part of this investigation. During the study period, endoscopic procedures in the older group steadily increased in number in all endoscopy groups (all p<0.001). Further, pooled complication rates of bleeding, CVA, AMI, CHF, and death were approximately three times higher among older patients who underwent EGD or colonoscopy. Moreover, pooled complication rates of CVA, AMI, CHF, and death were approximately 2.2 to 5.0 times higher among older patients who underwent colonoscopic polypectomy.Conclusions: Elderly patients experienced approximately three times more GI and non-GI complications after EGD or colonoscopy than young patients. Physicians should pay attention to the potential risks of GI endoscopy in elderly patients.

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“…Owing to this, it could lead to delayed diagnosis. The incidence of complications reported in the literature is 5% to 10% [16, 17]. The ERAS program can reduce the inflammatory response after surgical trauma [18].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of enhanced recovery after surgery in elderly patients after therapeutic endoscopic retrograde cholangiopancreatography.

Niu

Liu

Rongxia

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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IntroductionThe number of elderly patients with biliary and pancreatic diseases has increased significantly. The characteristics of biliary and pancreatic diseases in the elderly increase the risk of treatment.AimTo study the safety and efficacy of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients with biliary and pancreatic diseases with the concept of enhanced recovery after surgery (ERAS).Material and methodsPatients receiving ERCP under ERAS were grouped into an elderly group (group A, n = 58, aged 75 years or above) and a young and middle-aged group (group B, n = 202, aged less than 60 years). The clinical parameters before, during and after the operation of the two groups were compared.ResultsBefore the operation, the incidences of cholangiocarcinoma and complications, nutritional screening score ≥ 3, ASA degree III and Child-Pugh grade A in group A were significantly higher than those in group B (p < 0.05), while the incidences of nausea and vomiting, abdominal pain, nutritional screening < 3 and ASA grade I in group A were significantly lower than those in group B (p < 0.05). Intraoperatively, the incidence of juxta-ampullary duodenal diverticulum (JAD) in internal or bottom papilla in the elder patients with difficult selective biliary cannulation (DSBC) was significantly higher than that in the young and middle-aged group (p < 0.05). In addition, the continuous ECG monitoring duration and the first exhaust time in group A were significantly longer than those in group B (p < 0.05).ConclusionsEndoscopic retrograde cholangiopancreatography under ERAS in elderly patients is as safe and effective as in young patients.

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Endoscopy in the Elderly

Cited by 20 publications

References 81 publications

The Three-Year Incidence of Major Hemorrhage among Older Adults Initiating Chronic Dialysis

The Three-Year Incidence of Major Hemorrhage among Older Adults Initiating Chronic Dialysis

Gastrointestinal and Nongastrointestinal Complications of Esophagogastroduodenoscopy and Colonoscopy in the Real World: A Nationwide Standard Cohort Using the Common Data Model Database

Safety and efficacy of enhanced recovery after surgery in elderly patients after therapeutic endoscopic retrograde cholangiopancreatography.

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