COLONOSCOPY IN THE ELDERLY - LOW-RISK, HIGH-YIELD

An evaluation of the utility, morbidity, and patient tolerance of colo noscopy in elderly (greater than or equal to 70 years) patients was un dertaken and compared to data for a similar group of younger patients (50-70 years) who underwent colonoscopy during the same 48 months. Dat a reviewed for both groups included demographics, indications for colo noscopy, effectiveness of bowel preparation, colonoscopy completion, e ndoscopic findings, and complications. The mean age of the entire 656- patient population was 69 +/- 10 years; 87 (25%) of the 354 elderly pa tients were greater than 80 years of age and the average age of the 30 2-member control group was 59.8 +/- 5.8 years. Indications for colonos copy were the same in both groups and included rectal bleeding, 134 (2 0%); prior colorectal operation, 115 (18%); a history of adenomatous p olyps, 82 (12%); guaiac-positive stools, 49 (8%); abnormal finding on barium enema, 19 (3%); and miscellaneous other gastrointestinal sympto ms, 151 (23%). Screening colonoscopy was performed in 106 (16%). Colon oscopy was successfully completed to the cecum or the ileocolic anasto mosis in 85% (555/656) of the entire population. Only 78% (275/354) of elderly patients had colonoscopy successfully completed compared to 9 3% (281/302) of their younger counterparts (P = 0.001). Elderly patien ts were significantly more likely to have an abnormality than younger patients (74% vs 60%, P < 0.05). Malignant colorectal neoplasia was mo re common in the elderly (6% vs 2%, P = 0.03); however, benign neoplas ia was equally present in both age groups (30% vs 27%, P = NS). Thirty percent (195/656) of all patients underwent either snare polypectomy or biopsy. There were no perforations, and postprocedural hemorrhage o ccurred in 2% (4/195) and was unrelated to age. Overall morbidity, inc luding procedural-related oxygen desaturation, was no different betwee n the two groups. There were no deaths. We conclude that colonoscopy i s safe in elderly patients and that advanced age does not, by itself, confer increased risk to the procedure. The lower completion rate in e lderly patients mandated additional subsequent testing to complete col onic evaluation but was offset by the significantly increased likeliho od of discovering treatable pathology. These results support the conti nued, aggressive use of colonoscopy in the colonic evaluation of the e lderly.