Colonoscopy in the elderly

An evaluation of the utility, morbidity, and patient tolerance of colonoscopy in elderly (70 years) patients was undertaken and compared to data for a similar group of younger patients (50–70 years) who underwent colonoscopy during the same 48 months. Data reviewed for both groups included demographics, indications for colonoscopy, effectiveness of bowel preparation, colonoscopy completion, endoscopic findings, and complications. The mean age of the entire 656-patient population was 69±10 years; 87 (25%) of the 354 elderly patients were greater than 80 years of age and the average age of the 302-member control group was 59.8±5.8 years. Indications for colonoscopy were the same in both groups and included rectal bleeding, 134 (20%); prior colorectal operation, 115 (18%); a history of adenomatous polyps, 82 (12%); guaiac-positive stools, 49 (8%); abnormal finding on barium enema, 19 (3%); and miscellaneous other gastrointestinal symptoms, 151 (23%). Screening colonoscopy was performed in 106 (16%). Colonoscopy was successfully completed to the cecum or the ileocolic anastomosis in 85% (555/656) of the entire population. Only 78% (275/354) of elderly patients had colonoscopy successfully completed compared to 93% (281/302) of their younger counterparts (P=0.001). Elderly patients were significantly more likely to have an abnormality than younger patients (74% vs 60%, P<0.05). Malignant colorectal neoplasia was more common in the elderly (6% vs 2%, P=0.03); however, benign neoplasia was equally present in both age groups (30% vs 27%, P=NS). Thirty percent (195/656) of all patients underwent either snare polypectomy or biopsy. There were no perforations, and postprocedural hemorrhage occurred in 2% (4/195) and was unrelated to age. Overall morbidity, including procedural-related oxygen desaturation, was no different between the two groups. There were no deaths. We conclude that colonoscopy is safe in elderly patients and that advanced age does not, by itself, confer increased risk to the procedure. The lower completion rate in elderly patients mandated additional subsequent testing to complete colonic evaluation but was offset by the significantly increased likelihood of discovering treatable pathology. These results support the continued, aggressive use of colonoscopy in the colonic evaluation of the elderly.