Colonoscopy can be performed safely in very elderly patients

Interventional gastroenterology

By Mardi Chapman

15 Mar 2023

Colonoscopy can be performed safely in carefully selected patients in the very elderly age group above 90 years of age, according to Australian data.

A retrospective study of 60 patients, 90-100 years of age, who underwent colonoscopies at two Sydney hospitals, has shown no post-colonoscopy complications or readmissions and no 30-day morbidity or mortality associated with the procedure.

The study, published in the ANZ Journal of Surgery [link here], included both public and private patients undergoing colonoscopy between January 2018 and November 2022.

Most patients (70%) were American Society of Anaesthesiologists (ASA) classification III with about 12% having poorer physical status (ASA IV) and the rest having better health (ASA II) with one patient regarded as having normal good health (ASA I).

Reasons for the emergency or elective colonoscopies included rectal bleeding (40%), anaemia (22%), polyp surveillance (10%), a positive FOBT (8%) or cancer surveillance (7%).

Significant colonoscopy findings included rectal or caecal cancer (seven patients or 11.7%), multiple >5 polyps (six patients) and angioectasia (two patients).

“Most patients were either discharged on the same day of colonoscopy or observed overnight and discharged the subsequent day,” the study said.

“Prolonged length of stay in the hospital (more than 1 night) after the colonoscopy was due to reasons such as: stayed in hospital to await definitive surgery, awaiting rehab bed, medical management of other co-morbidities unrelated to colonoscopy and discharge planning.”

“There were no complications after the colonoscopy. There were no 30-day readmission, or 30-day mortality/morbidity related to the colonoscopy.”

Five patients proceeded to surgeries, either hemicolectomy or abdominoperineal resection.

“For those who presented with rectal bleeding and had undergone an emergency colonoscopy, 9.1% had a cancer detected. None of these patients had any complications or mortality post-colonoscopy, or post cancer surgery,” the study said.

“As the likelihood of colorectal malignancy in this population is higher, when patients proceed to surgery, they yield a better survival outcome than those who received palliate treatment alone.”

The investigators, including gastroenterologist Dr Graeme Rich, said the literature suggests a higher proportion of colonoscopy complications with advancing age.

“Although adverse effects appear to be more common in older patients, the absence of significant complications and comparatively high yield of colorectal malignancy reinforces the value of colonoscopy as a diagnostic tool that can be safely performed in the nonagenarian population.”

They said the overall health status of the patient should be considered before colonoscopy as age alone does not confer an increased risk.

“Further research is required as we aim to be able to provide more evidence-based insight towards the burden of treatment, possible treatment outcomes and their likelihood when discussing regarding potential surgical intervention with patients and their family,” the investigators concluded.

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