Predictors of Failed Colonoscopy in Nonagenarians

Schmilovitz‐Weiss, Hemda; Weiss, Avraham; Boaz, Mona; Levin, I. Michael; Chervinski, Alexandra; Shemesh, E

doi:10.1097/01.mcg.0000225666.46050.78

Cited by 33 publications

(16 citation statements)

References 33 publications

(28 reference statements)

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“…57 Also, failure to successfully complete a colonoscopy is reported to be higher in older patients. 14,58,59 However, among our included studies, there were scant adverse outcome data present to make meaningful comparisons between older and younger patients and these potential factors.…”

Section: Discussionmentioning

confidence: 99%

Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis

Day

Kwon

Inadomi

et al. 2011

Gastrointestinal Endoscopy

219

167

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Background Studies suggest that advancing age is an independent risk factor for experiencing adverse events during colonoscopy. Yet many of these studies are limited by small sample sizes and/or marked variation in reported outcomes. Objective To determine the incidence rates for specific adverse events in elderly patients undergoing colonoscopy and calculate incidence rate ratios for selected comparison groups. Setting and Patients Elderly patients undergoing colonoscopy. Design Systematic review and meta-analysis. Main Outcome Measurements Perforation, bleeding, cardiovascular (CV)/pulmonary complications, and mortality. Results Our literature search yielded 3328 articles, of which 20 studies met our inclusion criteria. Pooled incidence rates for adverse events (per 1000 colonoscopies) in patients 65 years of age and older were 26.0 (95% CI, 25.0–27.0) for cumulative GI adverse events, 1.0 (95% CI, 0.9–1.5) for perforation, 6.3 (95% CI, 5.7–7.0) for GI bleeding, 19.1 (95% CI, 18.0–20.3) for CV/pulmonary complications, and 1.0 (95% CI, 0.7–2.2) for mortality. Among octogenarians, adverse events (per 1000 colonoscopies) were as follows: cumulative GI adverse event rate of 34.9 (95% CI, 31.9–38.0), perforation rate of 1.5 (95% CI, 1.1–1.9), GI bleeding rate of 2.4 (95% CI, 1.1–4.6), CV/pulmonary complication rate of 28.9 (95% CI, 26.2–31.8), and mortality rate of 0.5 (95% CI, 0.06–1.9). Patients 80 years of age and older experienced higher rates of cumulative GI adverse events (incidence rate ratio 1.7; 95% CI, 1.5–1.9) and had a greater risk of perforation (incidence rate ratio 1.6, 95% CI, 1.2–2.1) compared with younger patients (younger than 80 years of age). There was an increased trend toward higher rates of GI bleeding and CV/pulmonary complications in octogenarians but neither was statistically significant. Limitations Heterogeneity of studies included and not all complications related to colonoscopy were captured. Conclusions Elderly patients, especially octogenarians, appear to have a higher risk of complications during and after colonoscopy. These data should inform clinical decision making, the consent process, public health policy, and comparative effectiveness analyses.

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Section: Discussionmentioning

confidence: 99%

Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis

Day

Kwon

Inadomi

et al. 2011

Gastrointestinal Endoscopy

219

167

View full text Add to dashboard Cite

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“…In the very elderly population, several large studies have shown successful colonic preparation is more difficult to achieve despite patient compliance, tolerance, and the type of preparation used. [16][17][18] Poor preparation may be related to redundant colon length, intolerance to the volume of preparation, decreased autonomic innervation of the bowel, and colonic tortuosity. Another concern is the urgency with fecal incontinence and a higher risk of falls and fractures while getting to the bathroom, an event that can be avoided with proper planning and preprocedure assessment.…”

Section: Bowel Preparationmentioning

confidence: 98%

Endoscopy in the Elderly

Razavi

Gross

Katz

2014

Clinics in Geriatric Medicine

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“…Although colonoscopy is undeniably the most accurate procedure for polyp and cancer detection, its overall sensitivity in the elderly is reduced by a relatively high rate of incomplete examinations, with caecal intubation having been shown to fail in nearly 40% of very elderly patients [7]. Colonoscopy feasibility in the elderly is further reduced by a decrease compliance to bowel preparation, mainly because of associated co-morbidities such as Parkinson's disease, cardiovascular, pulmonary or diabetes [8,9].…”

mentioning

confidence: 98%

CT colonography with reduced bowel preparation after incomplete colonoscopy in the elderly

et al. 2008

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We prospectively assessed the feasibility and acceptance of computerized tomographic colonography (CTC) without bowel cathartic preparation in elderly patients after incomplete colonoscopy. A total of 136 patients underwent CTC without cathartic preparation. The time delay between conventional colonoscopy and CTC ranged between 3 and 20 days, depending on the clinical situation. Before CTC, fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals. CTCs were interpreted using a primary two-dimensional (2D) approach and 3D images for further characterization. Patients were interviewed before and 2 weeks after CTC to assess preparation acceptance. CTC was feasible and technically successful in all the 136 patients. Fecal tagging was judged as excellent in 113 (83%) patients and sufficient in 23 (17%). Average CT image interpretation time was 14.8 min. Six (4.4%) cases of colorectal cancer and nine (6.6%) large polyps were detected, as well as 23 (11.3%) extracolonic findings of high clinical importance. No major side effect occurred, although 25% patients reported minor side effects, especially diarrhea. Overall, 76/98 patients replied that they would be willing to repeat the test if necessary. CTC without cathartic preparation is a technically feasible and safe procedure to complete a colonic study in the elderly, prompting its use in clinical practice.

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Predictors of Failed Colonoscopy in Nonagenarians

Abstract: Colonoscopy in nonagenarians is a safe procedure; however, it carries a significantly higher failure rate. Functional decline was found to be a significant predictive factor for failed colonoscopy.

Cited by 33 publications

References 33 publications

Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis

Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis

Endoscopy in the Elderly

CT colonography with reduced bowel preparation after incomplete colonoscopy in the elderly

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