Endoscopy in the Elderly: a Cautionary Approach, When to Stop.

OPINION STATEMENT: Performing endoscopic procedures in the elderly carries known enhanced risk compared to the general population. Weighing the benefits against the risks is easy when a patient is in immediate danger, but a gray area arises in screening protocols in an elderly patient of average risk. In this review, we compare national and international guidelines in average risk screening procedures (colonoscopic colorectal screening, Barrett's surveillance) to find consensus for screening practice in the elderly. With minor differences between societal guidelines, it is widely agreed that 75 years is the appropriate age to begin to weigh risks and benefits according to a patient's state of health and comorbidities. For colorectal screening, most guidelines advocate complete cessation of screening after the age of 85 years. Such consensus must take into account an aging population where patients are living healthier for longer and thus may be appropriate candidates for screening procedures even if beyond designated ages of screening cessation.