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

Myung, Jae; Kozarek, Richard A.; Selva, Danielle La; Glück, Michael; Ross, Andrew; Chiorean, Michael; Koch, Johannes; Lin, Otto S.

doi:10.1016/j.cgh.2015.06.036

Cited by 63 publications

(52 citation statements)

References 27 publications

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“…Similar to Cha et al, we found that increasing age alters the indications for colonoscopy because nonagenarians were more likely to undergo colonoscopy due to rectal bleeding, anemia, and following an episode of volvulus, and less likely for polyp surveillance. As opposed to other studies, we found that most of the nonagenarians were successfully and safely sedated and had a low procedure‐related complication rate.…”

Section: Discussionsupporting

confidence: 85%

“…We aimed to describe the performance, safety, outcomes, and impact of significant findings (ie, CRC) on the subsequent clinical management and prognosis of these patients. Only one study by Cha et al comparing 76 nonagenarians with 140 75‐ to 79‐year‐old patients reported that colonoscopy in this age group is safe and has a high yield; yet they did not report the clinical impact of findings during the procedure in management or prognosis.…”

Section: Discussionmentioning

confidence: 99%

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Colonoscopy in Nonagenarians Is Safe and May Be Associated with Clinical Benefit

Shafrir

Koslowsky

Wengrower

et al. 2019

J American Geriatrics Society

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OBJECTIVES Data regarding colonoscopy in patients older than 90 years old is scarce. Yet the number of colonoscopies done on nonagenarians is rising. We aimed to determine the yield, safety, and therapeutic benefits of colonoscopy in these patients. DESIGN Case‐control study of older patients who underwent colonoscopy. SETTING Gastroenterology institute at an academic medical center. PARTICIPANTS Patients older than 90 years (n = 128) compared with patients aged 80 to 89 years (n = 218) who underwent colonoscopy. INTERVENTION Colonoscopy. MEASUREMENTS Indication for the procedure, completion rates, adequacy of preparation, complications, colonoscopic findings, 30‐day mortality, advanced adenoma and carcinoma detection rate, treatment, and long‐term survival of patients diagnosed with colorectal cancer. RESULTS Mean ages were 83.3 and 92.2 years old. Nonagenarians were more likely to undergo a colonoscopy while hospitalized (56.2 vs 23.4%; P < .001) and to undergo the examination due to rectal bleeding or sigmoid volvulus (35.2 vs 25.2 and 10.9 vs 0.5%, respectively; P < .001) and less likely for surveillance or constipation (11.7 vs 25.7 and 0 vs 6.9%, respectively; P < .001). Completion rates and severe adverse events were comparable. The 30‐day mortality was 3.9% in nonagenarians and 0.4% in octogenarians (P = .02). Advanced adenomas and carcinoma were more common in nonagenarians (25.8 vs 16.5%, P = .03, and 14.8 vs 6.4%, P = .01, respectively). Increasing age, inpatient status, past polypectomy surveillance, and anemia were associated with higher rates of carcinoma. Half of the nonagenarians diagnosed with adenocarcinoma underwent surgery compared with 100% of octogenarians (P = .01). Among nonagenarians with colorectal cancer who died, mean survival was 605 (interquartile range = 11‐878) days in those who underwent surgery and 112 (48‐341) in those treated conservatively (P = .055 log‐rank test). CONCLUSION Colonoscopy in nonagenarians has a high yield and is generally safe. Colonoscopy findings lead to surgery in more than half of these patients and was associated with a median survival of 20 months.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Colonoscopy in Nonagenarians Is Safe and May Be Associated with Clinical Benefit

Shafrir

Koslowsky

Wengrower

et al. 2019

J American Geriatrics Society

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“…We found that the rate of colon adenomas and advanced neoplasias was significantly lower in patients 30–39 years of age compared to our screening cohort of patients 40 years of age or older. Remarkably, the rate of advanced neoplasia formation in the CF patients 40–49 years of age is comparable to that of nonagenarians in the general population [15]. An accelerated rate of polyp development and growth associated with CF is further suggested by the high detection rate of new adenomas, including advanced polyps, on surveillance and re-screening colonoscopies performed at relatively short intervals in our program despite optimized colon preparations that should have minimized missed polyps [11].…”

Section: Discussionmentioning

confidence: 97%

Colonoscopic screening shows increased early incidence and progression of adenomas in cystic fibrosis

Niccum

Billings

Dunitz

et al. 2016

Journal of Cystic Fibrosis

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Background Colorectal cancer is an emerging problem in cystic fibrosis (CF). The goal of this study was to evaluate adenoma detection by systematic colonoscopic screening and surveillance. Methods We analyzed prospectively collected results of colonoscopies initiated at age 40 years from 88 CF patients at a single Cystic Fibrosis Center. We also reviewed results of diagnostic colonoscopies from 27 patients aged 30–39 years performed during the same time period at the Center. Results The incidence of polyp detection increased markedly after age 40 in CF patients. Greater than 50% were found to have adenomatous polyps; approximately 25% had advanced adenomas as defined by size and/or histopathology; 3% were found to have colon cancer. Multivariate analysis demonstrated specific risk factors for adenoma formation and progression. Conclusions Early screening and more frequent surveillance should be considered in patients with CF due to early incidence and progression of adenomas in this patient population.

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“…In the context of older adults with previous colonoscopies with normal results who are at low risk for CRC, the harms of screening (including unnecessary discomfort, diminished quality of life, and procedure-related harm) are likely to outweigh the benefits. 10,11,12,13 …”

Section: Introductionmentioning

confidence: 99%

Patient Attitudes Toward Individualized Recommendations to Stop Low-Value Colorectal Cancer Screening

et al. 2018

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

Cited by 63 publications

References 27 publications

Colonoscopy in Nonagenarians Is Safe and May Be Associated with Clinical Benefit

Colonoscopy in Nonagenarians Is Safe and May Be Associated with Clinical Benefit

Colonoscopic screening shows increased early incidence and progression of adenomas in cystic fibrosis

Patient Attitudes Toward Individualized Recommendations to Stop Low-Value Colorectal Cancer Screening

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