Background and Study Aims: Optical colonoscopy is considered the gold standard for colorectal examination and has the advantage of allowing biopsies and polypectomy. However, the data on its safety and effectiveness in the elderly population are limited and somewhat conflicting. We prospectively assessed whether there are differences in completion rates, diagnostic yield, complication rates and 30-day mortality between patients aged ≥ 65 years and patients aged < 65 undergoing colonoscopy at our centre.
Patients and Methods: Data were collected prospectively on 2000 colonoscopies performed over a 2-year period (January 2002 to January 2004). We compared 1000 consecutive colonoscopies in patients aged ≥ 65 with 1000 consecutive colonoscopies in patients aged < 65 (control group). Data were collected on sedation; on completion rates, both crude and adjusted to discount failures due to obstructive disease; on diagnostic yield; complications, and on 30-day mortality.
Results: The median age was 75 years (51 % women) for the elderly group and 54 years (59 % women) for controls. The proportion of patients who received sedation was similar for both groups (59 % vs. 62 %, P = 0.97) but the mean dose of midazolam was lower in the elderly group (3.8 mg vs. 4.5 mg, P < 0.0001). The crude completion rate was lower for the elderly group (81.8 % vs. 86.5 %, P = 0.004), but the adjusted rate was similar for both groups (88.1 % elderly vs. 87.6 % control, P = 0.18). The overall diagnostic yield was higher in the elderly group (65 % vs. 45 %, P < 0.0001) with higher rates of carcinoma detected (7.1 % vs. 1.3 %, P < 0.0001). The complication rate was low (0.2 % per group).
Conclusions: Colonoscopy in the elderly is safe and effective with a high diagnostic yield. Colonoscopy may now be the imaging modality of choice in the elderly population.
References
-
1
Rhodes J M.
Colorectal cancer screening in the UK: Joint Position Statement by the British Society of Gastroenterology, The Royal College of Physicians, and The Association of Coloproctology of Great Britain and Ireland.
Gut.
2000;
46
746-748
-
2 American Cancer Society (1995) .Cancer Facts and Figures 1995. Atlanta; American Cancer Society 1995
-
3
Overholt B F, Pollard H M.
Cancer of the colon and rectum. Current procedures for detection and diagnosis.
Cancer.
1967;
20
445-450
-
4
Hurlstone D P, Fujii T, Lobo A J.
Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy.
Br J Surg.
2002;
89
272-282
-
5
Winawer S J, Stewart E T, Zauber A G. et al .
A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group.
N Engl J Med.
2000;
342
1766-1772
-
6
Winawer S H, Flehinger B J, Schottenfeld D, Miller D G.
Screening for colorectal cancer with fecal occult blood testing and sigmoidoscopy.
J Natl Cancer Inst.
1993;
85
1311-1318
-
7
Macrae F A, Tan K G, Williams C B.
Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies.
Gut.
1983;
24
376-383
-
8
Ghazi A, Grossman M.
Complications of colonoscopy and polypectomy.
Surg Clin N Am.
1982;
62
889-896
-
9
DiPrima R E, Barkin J S, Blinder M. et al .
Age as a risk factor in colonoscopy: fact versus fiction.
Am J Gastroenterol.
1988;
83
123-125
-
10
Bat L, Pines A, Shemesh E, Levo Y. et al .
Colonoscopy in patients aged 80 years or older and its contribution to the evaluation of rectal bleeding.
Postgrad Med J.
1992;
68
355-358
-
11
Chatrenet P, Friocourt P, Ramain J P. et al .
Colonoscopy in the elderly: a study of 200 cases.
Eur J Med.
1993;
2
411-413
-
12
Burtin P, Bour B, Charlois T. et al .
Colonic investigations in the elderly: colonoscopy or barium enema?.
Aging (Milano).
1995;
7
190-194
-
13
Ure T, Dehghan K, Vernava A M 3rd. et al .
Colonoscopy in the elderly. Low risk, high yield.
Surg Endosc.
1995;
9
505-508
-
14
Arora A, Singh P.
Colonoscopy in patients 80 years of age and older is safe, with high success rate and diagnostic yield.
Gastrointest Endosc.
2004;
60
408-413
-
15
Hurlstone D P, Cross S S, Drew K. et al .
An evaluation of colorectal endoscopic mucosal resection using high-magnification chromoscopic colonoscopy: a prospective study of 1000 colonoscopies.
Endoscopy.
2004;
36
491-498
-
16
Lukens F J, Loeb D S, Machicao V I. et al .
Colonoscopy in octogenarians: a prospective outpatient study.
Am J Gastroenterol.
2002;
97
1722-1725
-
17
Bowles C J, Leicester R, Romaya C. et al .
A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?.
Gut.
2004;
53
277-283
-
18 Joint Advisory Group on Gastrointestinal Endoscopy 2001 .Guidelines for the training, appraisal and assessment of trainees in gastrointestinal endoscopy. Available from British Society of Gastroenterology http://www.BSG.org.uk/sections/endoscopy.htm
-
19 Expert Advisory Group of the Royal College of Surgeons of England and the Association of Coloproctologists of Great Britain and Ireland .Guidelines for the management of colorectal cancer. London; Royal College of Surgeons of England 1996: 15-16
-
20
Gurwitz J H, Noonan J P, Sanchez M, Prather W.
Barium enemas in the frail elderly.
Am J Med.
1992;
92
41-44
-
21
Segal R, Khahil A, Leibovitz A, Gil I. et al .
Barium enema in frail elderly patients.
Gerontology.
2000;
46
78-82
-
22
Rex D K, Rahmani E, Haserman J. et al .
Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice.
Gastroenterology.
1997;
112
17-23
-
23
Lagares-Garcia J A, Kurek S, Collier B. et al .
Colonoscopy in octogenarians and older patients.
Surg Endosc.
2001;
15
262-265
-
24
Ulmer B J, Hansen J J, Overley C A. et al .
Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists.
Clin Gastroenterol Hepatol.
2003;
1
425-432
-
25
Cohen L B, Dubovsky A N, Aisenberg J, Miller K M.
Propofol for endoscopic sedation: a protocol for safe and effective administration by the gastroenterologist.
Gastrointest Endosc.
2003;
58
725-732
-
26
Cohen L B, Hightower C D, Wood D A. et al .
Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam.
Gastrointest Endosc.
2004;
59
795-803
-
27
Kulling D, Rothenbuhler R, Inauen W.
Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy.
Endoscopy.
2003;
35
679-682
D. P. Hurlstone, M. B. Ch. B.
Room P39/Ward P2, The Gastroenterology and Liver Unit
Royal Hallamshire Hospital · Sheffield S10 2JF · South Yorkshire · United Kingdom
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eMail: p.hurlstone@shef.ac.uk
