Audrey H Calderwood1,2, Jennifer L Holub3, David A Greenwald4, Douglas J Robertson5. 1. Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. 2. The Geisel School of Medicine at Dartmouth and the Dartmouth Institute of Health Policy and Clinical Practice, Hanover, New Hampshire, USA. 3. GI Quality Improvement Consortium, Bethesda, Maryland, USA. 4. Department of Medicine, Mount Sinai Hospital, New York, New York, USA. 5. Department of Veterans Affairs Medical Center, White River Junction, Hartford, Vermont, USA.
Abstract
OBJECTIVES: There is little guidance regarding when to stop surveillance colonoscopy in individuals with a history of adenomas or colorectal cancer (CRC). We evaluated both yield and recommendations for follow-up colonoscopy in a large cohort of older individuals undergoing colonoscopy, using the GI Quality Improvement Consortium registry. METHODS: We analyzed the yield of colonoscopy in adults aged ≥75 years, comparing those who had an indication of surveillance as opposed to an indication of diagnostic or screening, stratified by 5-year age groups. Our primary outcome was CRC and advanced lesions. We also evaluated recommended follow-up intervals by age and findings. RESULTS: Between 2010 and 2017, 376,686 colonoscopies were performed by 3,976 endoscopists at 628 sites, of which 43.2% were for surveillance. Detection of CRC among surveillance patients increased with age from 0.51% (age 75-79 years) to 1.8% (age ≥ 90 years); however, these risks were lower when compared with both the diagnostic and screening for the same age band (P < 0.0001). Yield of advanced lesions also increased by every 5-year interval of age across all groups by indication. Even at the most advanced ages and in those with nonadvanced findings, only a minority of patients were recommended for no further colonoscopy. For example, in patients aged 90 years and older with only low risk findings, 62.9% were recommended to repeat colonoscopy. DISCUSSION: Surveillance colonoscopy is frequently recommended at advanced ages even when recent findings may be clinically insignificant. Further work is needed to develop guidelines to inform best practice around when to stop surveillance in older adults.
OBJECTIVES: There is little guidance regarding when to stop surveillance colonoscopy in individuals with a history of adenomas or colorectal cancer (CRC). We evaluated both yield and recommendations for follow-up colonoscopy in a large cohort of older individuals undergoing colonoscopy, using the GI Quality Improvement Consortium registry. METHODS: We analyzed the yield of colonoscopy in adults aged ≥75 years, comparing those who had an indication of surveillance as opposed to an indication of diagnostic or screening, stratified by 5-year age groups. Our primary outcome was CRC and advanced lesions. We also evaluated recommended follow-up intervals by age and findings. RESULTS: Between 2010 and 2017, 376,686 colonoscopies were performed by 3,976 endoscopists at 628 sites, of which 43.2% were for surveillance. Detection of CRC among surveillance patients increased with age from 0.51% (age 75-79 years) to 1.8% (age ≥ 90 years); however, these risks were lower when compared with both the diagnostic and screening for the same age band (P < 0.0001). Yield of advanced lesions also increased by every 5-year interval of age across all groups by indication. Even at the most advanced ages and in those with nonadvanced findings, only a minority of patients were recommended for no further colonoscopy. For example, in patients aged 90 years and older with only low risk findings, 62.9% were recommended to repeat colonoscopy. DISCUSSION: Surveillance colonoscopy is frequently recommended at advanced ages even when recent findings may be clinically insignificant. Further work is needed to develop guidelines to inform best practice around when to stop surveillance in older adults.
Authors: Audrey H Calderwood; Tor D Tosteson; Louise C Walter; Peiying Hua; Tracy Onega Journal: J Am Geriatr Soc Date: 2021-12-03 Impact factor: 5.562
Authors: Gregory A Coté; B Joseph Elmunzer; Erin Forster; Robert A Moran; John G Quiles; Daniel S Strand; Dushant S Uppal; Andrew Y Wang; Peter B Cotton; Michael G McMurtry; James M Scheiman Journal: Tech Innov Gastrointest Endosc Date: 2021-01-18