Learning from adverse outcomes: guidelines on colonoscopic polypectomy in patients aged 85 years and older.

A patient between 80 and 90 years of age died following a polypectomy as part of a colonoscopy surveillance programme for previous polyps. As a consequence of this adverse event, we have amended our local guidelines. While perforation is a recognised complication of polypectomy, it was felt that the decision taken to remove the polyp was incorrect. The decision to remove a polyp should be at the endoscopist's clinical discretion and should depend on polyp size, the patient's age and comorbidities and their performance status. We recommend that polyps <20 mm in size should be regarded as low-risk polyps and that polypectomy of low-risk polyps are not essential in patients aged 85 years and older. Polypectomy of high-risk polyps in patients aged 85 years and older should only be undertaken by experienced endoscopists and with appropriate discussion with the patient prior to the procedure. Patients aged >80 years should be dissuaded from having further colonoscopic surveillance and should not be included in polyp detection rate reports to ensure that polypectomy decisions are not influenced by performance monitoring. We recommend other endoscopy units review their local practice and consider introducing these (or similar) guidelines to reduce risk to older patients. We also recommend that the British Society of Gastroenterology should include more specific guidance on surveillance and polypectomy in the older patient when the guidance is next reviewed.