Colonoscopy in the octogenarian population: Diagnostic and survival outcomes from a large series of patients

Khan, Shakeeb; Ahmed, Jamil; Lim, Michael; Owais, Anwar; McNaught, Clare; Mainprize, K. S.; Babu, Sathish; Renwick, Ian; MacFie, John; Mitchell, C. J.

doi:10.1016/j.surge.2010.09.003

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…Bowel preparation is an important factor in the quality of colonoscopy [1,2], and poor preparation may lead to inability to reach the cecum, poor visualization of the mucosa, potential nondetection of lesions, and the necessity for repeat examinations. Factors increasing the risk for poor bowel preparation may include older age, lower education level, long waiting time for colonoscopy appointment and nonadherence to preparation instructions [6,7]. These issues need to be addressed when high quality colonoscopy is desired.…”

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confidence: 99%

A novel device to improve colon cleanliness during colonoscopy

et al. 2012

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A novel device to improve colon cleanliness during colonoscopy

et al. 2012

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“…Incidence of CRC in our elderly cohort was 10 times less than the SEER data when examining the CRC incidence rate by age (≥75 years) for the year 2000-2011. 29 In a retrospective study by Khan et al, 11 it was found that increasing age was associated with increased risk of malignancy. However, no specification was made whether elderly patients in this study had undergone prior colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Surveillance Colonoscopy in Elderly Patients

Tran

Ngor

2014

JAMA Intern Med

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IMPORTANCEThe risks and benefits of surveillance colonoscopy in elderly patients have not been well characterized.OBJECTIVE To investigate the relative impact of surveillance colonoscopy in elderly patients compared with a reference cohort. DESIGN, SETTING, AND PARTICIPANTSRetrospective cohort study from 2001 through 2010 of patients 50 years and older undergoing surveillance colonoscopy for a history of colorectal cancer (CRC) or adenomatous polyps at an integrated health care system in southern California. Patients were followed up from the surveillance examination until CRC diagnosis, death, disenrollment, IBD diagnosis, or study end date (December 31, 2010). MAIN OUTCOMES AND MEASURESThe primary outcome measure was incidence of CRC detected following surveillance colonoscopy. The secondary outcome was risk of procedure defined as postprocedure hospitalization within 30 days. Cox regression and multivariable logistic regression analyses were used to determine the impact of age on CRC incidence on surveillance examination as well as postprocedure hospitalization, respectively. RESULTSThe study cohort included 4834 elderly patients (age Ն75 years; 55.8% male) (median surveillance age, 79 years) and 22 929 individuals in the reference group (age 50-74 years; 57.7% male) (median surveillance age, 63 years). A total of 373 cancers were detected following surveillance colonoscopy (368 in the reference group and 5 among the elderly patients). There were a total of 711 postprocedure hospitalizations (184 in the reference group and 527 among the elderly patients). The CRC incidence among elderly patients undergoing surveillance was 0.24 per 1000 person-years vs 3.61 per 1000 person-years in the reference population (P < .001). In Cox regression analysis, the hazard ratio for CRC in the elderly patients compared with the reference group was 0.06 (95% CI, 0.02-0.13) (P < .001) after adjusting for comorbid illness, sex, and race/ethnicity. In logistic regression analysis, age 75 years and older was independently associated with increased risk of postprocedure hospitalization (adjusted odds ratio, 1.28 [95% CI, 1.07-1.53]; P = .006). Charlson score of 2 was also independently associated with increased risk of postprocedure hospitalization (adjusted odds ratio, 2.54 [95% CI, 2.06-3.14]; P < .001). CONCLUSIONS AND RELEVANCEA low incidence of CRC and relatively high rate of postprocedure hospitalization were found among elderly patients undergoing surveillance colonoscopy. Recommendations for ongoing surveillance in the elderly population should take into consideration the impact of comorbid illness and increasing age on the anticipated risks and benefits of colonoscopy.

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“…Prior studies of surveillance colonoscopy yield in older populations have reported conflicting results. Four studies reported that the prevalence of CRC and adenoma detection increased with age . For example, a study using the New Hampshire Colonoscopy Registry showed that CRC yield at surveillance colonoscopy was low but increased from 0.4% to 0.6% and 0.8% among older adults aged 70-74, 75-79, and 80-84 years, respectively .…”

Section: Discussionmentioning

confidence: 99%

“…Four studies reported that the prevalence of CRC and adenoma detection increased with age . For example, a study using the New Hampshire Colonoscopy Registry showed that CRC yield at surveillance colonoscopy was low but increased from 0.4% to 0.6% and 0.8% among older adults aged 70-74, 75-79, and 80-84 years, respectively . In contrast, 3 other studies reported that CRC prevalence decreased with age .…”

Section: Discussionmentioning

confidence: 99%

“…In weighing the pros and cons of surveillance colonoscopy in older adults, information needed for shared decision-making between patients and clinicians includes the yields of CRC and advanced neoplasia at surveillance colonoscopy in this age group. Prior studies examining yields in older adults with a history of colorectal polyps have been limited by small sample sizes, limited racial and ethnic representation, and inability to examine yields stratified by prior colonoscopy findings and age . To address this knowledge gap, we evaluated the surveillance colonoscopy yields of CRC and advanced neoplasia in patients 70 to 85 years of age with a prior adenoma finding from a large, demographically diverse, community-based US health care system.…”

Section: Introductionmentioning

confidence: 99%

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Surveillance Colonoscopy Findings in Older Adults With a History of Colorectal Adenomas

Lee,

Roy,

Jensen

et al. 2024

JAMA Netw Open

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ImportancePostpolypectomy surveillance is a common colonoscopy indication in older adults; however, guidelines provide little direction on when to stop surveillance in this population.ObjectiveTo estimate surveillance colonoscopy yields in older adults.Design, Setting, and ParticipantsThis population-based cross-sectional study included individuals 70 to 85 years of age who received surveillance colonoscopy at a large, community-based US health care system between January 1, 2017, and December 31, 2019; had an adenoma detected 12 or more months previously; and had at least 1 year of health plan enrollment before surveillance. Individuals were excluded due to prior colorectal cancer (CRC), hereditary CRC syndrome, inflammatory bowel disease, or prior colectomy or if the surveillance colonoscopy had an inadequate bowel preparation or was incomplete. Data were analyzed from September 1, 2022, to February 22, 2024.ExposuresAge (70-74, 75-79, or 80-85 years) at surveillance colonoscopy and prior adenoma finding (ie, advanced adenoma vs nonadvanced adenoma).Main Outcomes and MeasuresThe main outcomes were yields of CRC, advanced adenoma, and advanced neoplasia overall (all ages) by age group and by both age group and prior adenoma finding. Multivariable logistic regression was used to identify factors associated with advanced neoplasia detection at surveillance.ResultsOf 9740 surveillance colonoscopies among 9601 patients, 5895 (60.5%) were in men, and 5738 (58.9%), 3225 (33.1%), and 777 (8.0%) were performed in those aged 70-74, 75-79, and 80-85 years, respectively. Overall, CRC yields were found in 28 procedures (0.3%), advanced adenoma in 1141 (11.7%), and advanced neoplasia in 1169 (12.0%); yields did not differ significantly across age groups. Overall, CRC yields were higher for colonoscopies among patients with a prior advanced adenoma vs nonadvanced adenoma (12 of 2305 [0.5%] vs 16 of 7435 [0.2%]; P = .02), and the same was observed for advanced neoplasia (380 of 2305 [16.5%] vs 789 of 7435 [10.6%]; P &lt; .001). Factors associated with advanced neoplasia at surveillance were prior advanced adenoma (adjusted odds ratio [AOR], 1.65; 95% CI, 1.44-1.88), body mass index of 30 or greater vs less than 25 (AOR, 1.21; 95% CI, 1.03-1.44), and having ever smoked tobacco (AOR, 1.14; 95% CI, 1.01-1.30). Asian or Pacific Islander race was inversely associated with advanced neoplasia (AOR, 0.81; 95% CI, 0.67-0.99).Conclusions and RelevanceIn this cross-sectional study of surveillance colonoscopy yield in older adults, CRC detection was rare regardless of prior adenoma finding, whereas the advanced neoplasia yield was 12.0% overall. Yields were higher among those with a prior advanced adenoma than among those with prior nonadvanced adenoma and did not increase significantly with age. These findings can help inform whether to continue surveillance colonoscopy in older adults.

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Colonoscopy in the octogenarian population: Diagnostic and survival outcomes from a large series of patients

Cited by 8 publications

References 25 publications

A novel device to improve colon cleanliness during colonoscopy

A novel device to improve colon cleanliness during colonoscopy

Surveillance Colonoscopy in Elderly Patients

Surveillance Colonoscopy Findings in Older Adults With a History of Colorectal Adenomas

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