Colonoscopy Scheduling for Elderly Patients: Morning or Afternoon Sessions and Does It Make a Difference?

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Purpose: Colonoscopy in the elderly can be a technically challenging procedure and it may result, in case of incomplete tests, in inconvenience and extra healthcare costs. Time of colonoscopy is an easily modifiable factor, if it proved to impact on the completion rate. The aim of the study was to determine whether the time of a test (morning or afternoon session) impact on the success rate of cecal intubation. Methods: We retrospectively reviewed all colonoscopies performed between March 2006 and 2007 in an endoscopy unit of a District General Hospital in UK. Patients aged ≥ 75 years old were considered as elderly. Time of procedure was classified as morning (if before 12:59 hr) or afternoon session (if after 13:00 hr) and preparation as good or poor, according to report. Results: A total of 1885 colonoscopies was performed; (morning procedures 630, 347 [female] and 283 [male]; afternoon procedures1255, 698 [female] and 557 [male]). Four hundred eighty three (483) were performed in elderly patients, ([female] 286, [male] 197) and 324 in afternoon sessions ([female]196, [male]128). In 284 patients (83 morning, 201 afternoon) examination failed cecal intubation (15%) and in 235 (12.4%) preparation was poor (78 in morning sessions). Higher incompletion rate was found in elderly 93/483 (19.25%) vs. younger patients 191/1402 (13.6%), P < 0.05 and among women 184/1045 (17.6%) vs. men 100/ 840 (11.9%), P < 0.001; on the other hand, men ≥75 years old had worse preparation ([female] 28/286 or 9.9% vs. [male] 32/ 197 or 16.2%, P < 0.05). Regarding the afternoon sessions, [female]≥ 75 years old had higher cecal intubation failure rate than [female] < 75 years old (elderly [female] 46/196 or 23.4% vs. younger [female] 83/502 or 16.5%, P < 0.05) and than elderly men, as well (elderly [female] 46/196 or 23.4% vs. elderly [male] 16/128 or 12.5%, P < 0.05). No differences were observed in preparation either between sessions or between elderly and younger patients. Conclusion: Afternoon colonoscopies have an impact on the completion rate, especially in elderly women. Scheduling these colonoscopies in morning sessions might avoid the need for further procedures.