Endoscopic Outcomes in the Centenarian Population

Abstract

Introduction: With increasing life expectancy, the number of endoscopic procedures in the elderly and specifically, in patients over the age of 100, has dramatically increased in the United States. Potential benefits of these procedures need to be balanced against the competing risks of morbidity and mortality from other diseases in this age group. Studies have shown that endoscopy is feasible and safe in elderly patients. However, no study to date has looked at endoscopic outcomes in the centenarian (> 100 year old) patients. The aim of this study was to assess the diagnostic yield, complication rates, and procedural success rates of these endoscopic procedures. As a secondary outcome the study will look at anesthesia outcomes (i.e. length of procedure, sedation complications, etc.) in these patients. Methods: In a retrospective review, we studied data from all patients over the age of 100 undergoing endoscopic procedures at Maimonides Medical Center over a five year period. Primary outcomes including indications, procedure related mortality, and therapeutic success were reviewed. As a secondary outcome peri-procedure anesthesia records were reviewed. Results: A total of 50 patients over the age of the 100 were included in the study. The mean age was 100.6 (Max 104 Min 100), with 40 female patients and 10 males in the study. 44 of the patients were admitted patients and 6 were outpatient. Average ASA score was 4. 47 endoscopies and 2 colonoscopies were performed. 30 of the patients underwent a PEG or PEG replacement for dysphagia or failure to thrive. There were 9 GI bleeds (7 upper 2 lower) and 2 food impactions. All the patients tolerated the procedures well with a single episode hypotension and bradycardia. Conclusion: Gastrointestinal endoscopy is safe and well tolerated in the extremely elderly. Extreme age should not be the only factor influencing the decision to proceed with endoscopy in this population.