Yearly diagnostic yield of colonoscopy in patients age 80 years or older, with a special interest in colorectal cancer

Loffeld, R. J. L. F.; Liberov, Boris; Dekkers, P. E. P.

doi:10.1111/j.1447-0594.2011.00769.x

Cited by 19 publications

(16 citation statements)

References 12 publications

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“…Generally, the yield of colonoscopy increases with age [4] . According to Surveillance Epidemiology End Results (SEER) registry data as of 2007, the incidence of CRC is 120 cases per 100000 in persons aged 50-64 years of age, 186 per 100000 in those 65-74, and 290.1 per 100000 in those ≥ 75 [5] .…”

Section: Yieldmentioning

confidence: 99%

“…Studies on symptomatic patients (including those with non-traversable obstructing lesions) report completion rates of around 83% [29] . Colonoscopy in the elderly is technically more challenging than in younger patients because of various factors, including more extensive diverticulosis, higher incidence of tortuosity or post-surgical adhesions, and higher risk of complications [4] . Elderly patients are also less likely to tolerate large amounts of sedation, and have a higher probability of suffering inadequate bowel preparation [13,30,31] , both of which can preclude complete colonoscopy.…”

Section: Colonoscopy Completion Ratesmentioning

confidence: 99%

“…As summarized in Figure 1, elderly patients have a higher likelihood of poor bowel preparation due to slower colonic transit and higher incidence of obstipation [4,33] . Inadequate bowel preparation was a big factor in many studies that demonstrated lower colonoscopy completion rates in older patients [13,30,31] .…”

Section: Bowel Preparation Issuesmentioning

confidence: 99%

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

Lin

2014

WJGE

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Many diagnostic and screening colonoscopies are performed on very elderly patients. Although colonoscopic yield increases with age, the potential benefits in such patients decrease because of shorter life expectancy and more frequent comorbidities. Colonoscopy in very elderly patients carries a greater risk of complications and morbidity than in younger patients, and is associated with lower completion rates and higher likelihood of poor bowel preparation. Thus, screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks and patient preferences. On the other hand, diagnostic and therapeutic colonoscopy are more likely to benefit even very elderly patients, and in most cases should be performed if indicated.

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Section: Yieldmentioning

confidence: 99%

Section: Colonoscopy Completion Ratesmentioning

confidence: 99%

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

Lin

2014

WJGE

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“…In contrast, others have reported a high yield of CRC and polyps. 23,31 However, these studies included a wide range of age groups and, in particular, did not distinguish between surveillance or screening examinations. Literature review on posttreatment CRC recurrence also found high rates of CRC recurrence but only followed up patients for the first 1 to 2 years after curative surgical resection.…”

Section: Discussionmentioning

confidence: 98%

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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“…Moreover, unexpectedly, the prevalence of colorectal neoplasia peaked in the eighth decade of life and declined thereafter ( P =0.009) 20. Loffeld et al21 also showed that the percentage of patients with CRC and polyps among the very elderly increases at a slow rate compared to the increase in the percentage of the very elderly in the general population. These findings may further limit the value of colonoscopy in the very elderly population, especially in screening indications for asymptomatic cases.…”

Section: Diagnostic Yield Of Colonoscopymentioning

confidence: 98%

Would You Recommend Screening Colonoscopy for the Very Elderly?

Myung

2014

Intest Res

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Life expectancy in Korea has increased, and the number of screening colonoscopies in the elderly has also dramatically increased. The net benefit of colonoscopy in the very elderly (≥80 years of age as defined by the World Health Organization) may be reduced because of the competing risk of mortality due to other diseases. Therefore, the decision to perform screening colonoscopy may be more complex in this age group. As the potential increase in life expectancy due to screening colonoscopy is significantly reduced in the very elderly, this procedure should be limited to those among the very elderly who have substantial life expectancies. Furthermore, considering the common major complications associated with colonoscopy, poor bowel preparation, and the possibility of incomplete colonoscopies in the very elderly, the performance of screening colonoscopy in the very elderly may not be an ideal recommendation. In terms of providing the greatest benefit to the most number of people, patients with the highest potential gain in terms of life expectancy, relative to the diagnostic yield, should be targeted for colonoscopy screening. This review addresses the unique considerations regarding screening colonoscopy in the very elderly and the individualized approach, which involves the weighing of the risks and benefits for each individual with consideration of their overall health status.

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Yearly diagnostic yield of colonoscopy in patients age 80 years or older, with a special interest in colorectal cancer

Abstract: The yield of colonoscopy in patients 80 years or older was high and constant over the years. The number of tumors rose less than expected compared to the increase of elderly in the general population.

Cited by 19 publications

References 12 publications

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

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

Surveillance Colonoscopy in Elderly Patients

Would You Recommend Screening Colonoscopy for the Very Elderly?

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