Colonoscopy in the Elderly: diagnostic yield and outcomes.
Daniel Schmidt-Martin, Margaret Walshe, Zita Galvin, Una Kennedy, Nasir Mahmud
Department of Gastroenterology, St James’s Hospital, Dublin Department of Medicine, Trinity College Dublin
Colonoscopy in the elderly has been reported to be safe with a high diagnostic yield.
We aimed to evaluate the diagnostic yield at colonoscopy in elderly patients, investigate the long term outcomes of the pathology encountered, and examine whether there is appropriate pre procedure screening of potential patients.
We performed a retrospective review of all colonoscopies performed in 2010 on patients over 80 who were not attending for polyp follow up, or had a previous diagnosis of inflammatory bowel disease or colorectal cancer.
315 colonoscopies were performed on 285 patients at mean age 84 (80-96). Female:male ratio 2:1. 7 colorectal cancers were diagnosed (2.2 cancers per 100 procedures). Five patients underwent surgery. The five year survival for all cancers detected was 29% (n=2) Mortality was due to metastatic recurrence, cerebrovascular accident, and infective complications of COPD. The tumours were located in the rectum (1), sigmoid (3), hepatic flexure (1), and ascending colon (2). 116 polyps were identified in 65 patients (100 < 1cm). The caecal intubation rate was 78%. The procedure failed due poor prep in 10% of cases. Notably, only 16 of the 62 cases where the caecum was not reached underwent repeat endoscopy. 7 patients experienced a complication bradycardia (2), hypotension (1) and hypoxia requiring reversal of sedation (4) and major bleeding(1).
Colonoscopy is safe in the elderly and has a high diagnostic yield. Five year cancer survival is low as a result mainly of co-morbidity. The low rate of repeat procedures where the caecum was not intubated suggests that better pre procedure screening strategies may obviate the need for colonoscopy in a significant proportion of patients.