Amit Arora1, Pradip Singh. 1. Department of Gastroenterology, Staffordshire General Hospital, Weston Road, Stafford ST16 3SA, UK.
Abstract
BACKGROUND: Colonoscopy is the standard investigation for colonic disease, but clinicians often are reluctant to refer elderly patients for colonoscopy because of a perception of higher risk and a high rate of incomplete examinations. METHODS: Data were prospectively collected on 924 consecutive colonoscopies performed over a 31-month period. Comparisons were made between two groups: patients 80 years of age or older (Group O) and patients less than 80 years of age (Group Y). Data were collected on sedation, crude and adjusted total colonoscopy rates, ileoscopy rate, anus to cecum time, total procedure time, diagnostic yield, and complications. Appropriate exclusions were made to calculate procedure success rates and time. RESULTS: Patients in Group O (n=110) received significantly less sedative medication compared with Group Y (n=814) (median dosage for midazolam, 1 mg vs. 2.5 mg; median dosage for meperidine, 12.5 vs. 25 mg; p < 0.0001). The adjusted total colonoscopy rate was 97% and 99.2% for Group O and Group Y (not significant), respectively. Ileoscopy rate was significantly lower in Group O (71.1% vs. 86.1%; p=0.0004). Median anus to cecum time was significantly longer in Group O (9.75 vs. 8.5 minutes; p=0.0182) in a single test of hypothesis; however, Bonferroni correction for multiple testing of data removes this significance. Median total procedure time also was longer in Group O (22 vs. 18.5 minutes; p=0.0001). Diagnostic yield was high, and the complication rate was low for both groups. Colorectal cancer was detected in 20% patients in Group O and 7.4% in Group Y (p < 0.0001). CONCLUSIONS: Colonoscopy in patients 80 or more years of age is safe, effective, and has a high diagnostic yield. Procedure times are slightly longer, and the ileoscopy rate is lower in this age group.
BACKGROUND: Colonoscopy is the standard investigation for colonic disease, but clinicians often are reluctant to refer elderly patients for colonoscopy because of a perception of higher risk and a high rate of incomplete examinations. METHODS: Data were prospectively collected on 924 consecutive colonoscopies performed over a 31-month period. Comparisons were made between two groups: patients 80 years of age or older (Group O) and patients less than 80 years of age (Group Y). Data were collected on sedation, crude and adjusted total colonoscopy rates, ileoscopy rate, anus to cecum time, total procedure time, diagnostic yield, and complications. Appropriate exclusions were made to calculate procedure success rates and time. RESULTS:Patients in Group O (n=110) received significantly less sedative medication compared with Group Y (n=814) (median dosage for midazolam, 1 mg vs. 2.5 mg; median dosage for meperidine, 12.5 vs. 25 mg; p < 0.0001). The adjusted total colonoscopy rate was 97% and 99.2% for Group O and Group Y (not significant), respectively. Ileoscopy rate was significantly lower in Group O (71.1% vs. 86.1%; p=0.0004). Median anus to cecum time was significantly longer in Group O (9.75 vs. 8.5 minutes; p=0.0182) in a single test of hypothesis; however, Bonferroni correction for multiple testing of data removes this significance. Median total procedure time also was longer in Group O (22 vs. 18.5 minutes; p=0.0001). Diagnostic yield was high, and the complication rate was low for both groups. Colorectal cancer was detected in 20% patients in Group O and 7.4% in Group Y (p < 0.0001). CONCLUSIONS: Colonoscopy in patients 80 or more years of age is safe, effective, and has a high diagnostic yield. Procedure times are slightly longer, and the ileoscopy rate is lower in this age group.