Safety and Efficacy of Colonoscopy in Patients 85 Years and Older: Retrospective Review

Abstract

Introduction: To determine the safety and complication rate of colonoscopy in the population over 85 years and older in a single center outpatient ambulatory surgical unit. Methods: We under took a retrospective review of 410 patients ages 85 years and older from 2006 through 2012 in a single center outpatient ambulatory surgical center. We reviewed the charts of these patients to find indication for colonoscopy, comorbidities, whether sedation was given, the quality of the bowel preparation, whether cecal intubation or ileal visualization was accomplished, and any complications. Results: We reviewed 410 patients charts aged 85 years and older between 2006 and 2012. Mean age was 87.3 years, of which 228 (52.5%) of the patients were males. The leading indications for colonoscopy were: screening in 100 (38.2%), history of a polyp or cancer in 90 (34.4%), and history of bleeding and anemia in 38 (14.5%) patients. Heart disease was seen in 172(42.0%), lung disease in 52 (12.7%), and renal disease in 40 (9.8%) patients. One hundred eighty-nine (46.1%) patients did not receive any form of sedation during colonoscopy. Excellent to good quality bowel preparation was documented in 146 (59.6%), fair to adequate in 82 (39.6%) and poor in 2 (0.8%) patients. Polyps were detected in 122 patients with 87 (21.2%) having pre-cancerous polyps (tubular, tubulovillous, or villous) and 7 (1.7%) having colon cancer. Cecal intubation or ileal visualization was accomplished in all of the patients. Bleeding after the procedure was seen in 7 (1.7%) patients, but in no case was hospitalization or further intervention required. There were no perforations, cardiovascular complications, or pulmonary complications observed. Sixty-five patients were deceased at the time of chart review. We were able to find the cause of death only in 3 of these patients, which were unrelated to the procedure. Conclusion: The United States Preventive Services Task Force (USPSTF) recommends against colon cancer screening in the elderly population due to concerns over procedure-related complications. Over 70% of the population in this review underwent colonoscopy because there was a history of polyps or cancer or for screening. The complication rate in this review was negligible. With the increasing life span of people and reduced complications from colonoscopy, healthy elderly patients can consider colonoscopy for various indications. Further prospective study is needed to determine whether screening colonoscopies in the elderly can prolong life.