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Colonoscopy in Nonagenarians Is Safe and May Be Associated with Clinical Benefit
Author(s) -
Shafrir Asher,
Koslowsky Benjamin,
Wengrower Dov,
Goldin Eran,
Livovsky Dan M.
Publication year - 2019
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15832
Subject(s) - medicine , colonoscopy , constipation , colorectal cancer , adenoma , polypectomy , carcinoma , adverse effect , anemia , gastroenterology , diverticulosis , sigmoid colon , surgery , cancer , rectum
OBJECTIVES Data regarding colonoscopy in patients older than 90 years old is scarce. Yet the number of colonoscopies done on nonagenarians is rising. We aimed to determine the yield, safety, and therapeutic benefits of colonoscopy in these patients. DESIGN Case‐control study of older patients who underwent colonoscopy. SETTING Gastroenterology institute at an academic medical center. PARTICIPANTS Patients older than 90 years (n = 128) compared with patients aged 80 to 89 years (n = 218) who underwent colonoscopy. INTERVENTION Colonoscopy. MEASUREMENTS Indication for the procedure, completion rates, adequacy of preparation, complications, colonoscopic findings, 30‐day mortality, advanced adenoma and carcinoma detection rate, treatment, and long‐term survival of patients diagnosed with colorectal cancer. RESULTS Mean ages were 83.3 and 92.2 years old. Nonagenarians were more likely to undergo a colonoscopy while hospitalized (56.2 vs 23.4%; P < .001) and to undergo the examination due to rectal bleeding or sigmoid volvulus (35.2 vs 25.2 and 10.9 vs 0.5%, respectively; P < .001) and less likely for surveillance or constipation (11.7 vs 25.7 and 0 vs 6.9%, respectively; P < .001). Completion rates and severe adverse events were comparable. The 30‐day mortality was 3.9% in nonagenarians and 0.4% in octogenarians ( P = .02). Advanced adenomas and carcinoma were more common in nonagenarians (25.8 vs 16.5%, P = .03, and 14.8 vs 6.4%, P = .01, respectively). Increasing age, inpatient status, past polypectomy surveillance, and anemia were associated with higher rates of carcinoma. Half of the nonagenarians diagnosed with adenocarcinoma underwent surgery compared with 100% of octogenarians ( P = .01). Among nonagenarians with colorectal cancer who died, mean survival was 605 (interquartile range = 11‐878) days in those who underwent surgery and 112 (48‐341) in those treated conservatively ( P = .055 log‐rank test). CONCLUSION Colonoscopy in nonagenarians has a high yield and is generally safe. Colonoscopy findings lead to surgery in more than half of these patients and was associated with a median survival of 20 months.