Abstract
Objective:We aimed to determine the efficacy and safety of early (within the first 24 hour from application) endoscopy and colonoscopy in very elderly patients with GIS bleeding.Methods:In this study, 95 patients were included who underwent early endoscopy with the pre-diagnosis of upper GIS bleeding or endoscopy-colonoscopy with the pre-diagnosis of lower GIS bleeding between 2012 and 2016. Endoscopy and colonoscopy procedures were compared in terms of the development of complications, tolerance of procedure, detection of bleeding site, and rate of therapeutic interventions performed for bleeding. In addition, the adequacy of colonoscopy preparation was evaluated.Results:There was no significant difference between endoscopy and colonoscopy on procedural complication (2.1% vs 2.8%) and tolerance rates (81% vs 74.2), (p>0.05). The bleeding site was detected during endoscopy in 34(56.6%) patients, and an endoscopic intervention was required for 15(25%) of these patients. The bleeding site was detected during colonoscopy in 12(34.3%) patients, and an endoscopic intervention was performed for two (5.7%) patients (p<0.05). In addition, the colonoscopy procedure was suboptimal in 26 of 35 patients (74.2%) because of poor preparations.Conclusion:Early endoscopy and colonoscopy are safe and well tolerated in very elderly patients with GIS bleeding. Upper GIS endoscopy in this patient population enables the detection of the bleeding site and an endoscopic intervention for the bleeding. However, colonoscopy is insufficient for detecting bleeding sites, and colonoscopic treatment of bleeding sites is difficult because of poor or no preparation in this patient population.
Highlights
According to the 2010 World Health Organization (WHO) report, life expectancy has increased in the United States and almost worldwide
We evaluated patients aged>80 years who presented to the emergency service and for whom gastroenterology consultation was requested based on a pre-diagnosis of gastrointestinal system (GIS) bleeding
Our study showed that very elderly patients could tolerate early endoscopy and colonoscopy procedures performed following a pre-diagnosis of GIS bleeding without sedation
Summary
According to the 2010 World Health Organization (WHO) report, life expectancy has increased in the United States and almost worldwide. WHO defines elderly people as those aged ≥65 years and very elderly as those aged ≥80 years. 1. Mustafa Celik, Assistant Professor, Department of Gastroenterology, Medical Faculty, Pamukkale University Training and Research Hospital, Denizli; Turkey. Correspondence: Ocotber 8, 2016 Ocotber 19, 2016 December 25, 2016. The use of gastrointestinal endoscopy in geriatric patients is increasing as a larger proportion of the population is reaching an advanced age. Upper endoscopy in elderly patients often provides diagnostic information that affects clinical therapeutic decisions.[1,2,3] In this population, colonoscopy is mostly used for colorectal cancer screening and surveillance.[4]
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