S0323 Precancerous Polyp and Colorectal Cancer Detection Rates and Safety of Surveillance Colonoscopy in Individuals Aged 75 Years and Above

Abstract

INTRODUCTION: The risk of development of colorectal cancer (CRC) increases with age and history of colonic adenomas. Currently, there is limited data and lack of consensus about the age to discontinue surveillance colonoscopy in patients aged 75 and above who have had polyps in the past. Most guidelines recommend this decision to be considered individually. We aim to determine the precancerous polyp detection rate during surveillance colonoscopies and safety for individuals above age 75. METHODS: We conducted a retrospective chart review to identify patients who underwent a colonoscopy between the years of 2012 to 2019 and were over age 75. We collected data on patient characteristics, colonoscopy findings and histology of polyps. Exclusion criteria were patients with a history of CRC, polyposis syndromes, or Inflammatory Bowel Disease were excluded. Inclusion criteria included all colonoscopies being performed due to a history of colon polyps. Statistical analyses were conducted in SPSS version 26 to compute means and frequencies of patient characteristics and colonoscopy outcomes. RESULTS: A total of 591 colonoscopies were analyzed and 173 met the inclusion criteria. Median age was 78. A majority of the patients were female (55.5%) and Caucasian (92.5%). Good bowel preparation and high cecal intubation rates were consistent in all groups (Table 1). The majority of patients took aspirin (56.1%), had an ASA level 2 or less (71.7%) while a significant proportion had metabolic syndrome (43.3%), obesity (34.1%), alcohol abuse history (35.3%) and were ex-smokers (38.7%). Precancerous polyps were found in 15/173 (8.7%) colonoscopies. Most of the precancerous polyps were small, located in the proximal colon, and tubular or tubulovillous adenomas on histology (Table 2). The proportion of distal precancerous polyps increased with age. CRC was detected in the distal colon in one patient (0.57 %). No patients developed complications during or after their colonoscopy. CONCLUSION: In contrast to prior studies in the elderly which show a higher preponderance of polyps and/or cancer in the proximal colon, our limited data shows a higher rate of distal colon polyps and one distal CRC in the subgroup who are over age 85 (8% prevalence). There were no complications observed and the majority of the patients were healthy (ASA 1 or 2). Larger studies should be performed to further validate our findings while decision regarding surveillance colonoscopy should continue to be individualized.Table 1.: Demographics, colon cancer risk factors and quality features of surveillance colonoscopyTable 2.: Polyp and Colon cancer outcomes of surveillance colonoscopy