Colonoscopy in the elderly: low risk, low yield in asymptomatic patients.
OBJECTIVE
Current colonoscopy guidelines do not address the issue of when to stop performing screening and surveillance colonoscopy in the elderly. We reviewed our experience and results of colonoscopy in patients aged 80 years and older to assess the risks and diagnostic yield in this population.


METHODS
We reviewed retrospectively the endoscopic and pathologic reports from consecutive colonoscopies performed on patients aged 80 years and older at a single, high-volume endoscopy center between August 1999 and May 2003. Patient characteristics, indications for examination, findings at colonoscopy, and complications were recorded and analyzed.


RESULTS
A total of1,199 colonoscopic examinations were performed on 1,112 patients. Average age was 83.1 (range, 80-100) years. Male:female distribution was 1:1.7. Leading exclusive indications for colonoscopy included: polyp surveillance, 227 (19 percent); altered bowel habits, 168 (14 percent); iron-deficiency anemia, 132 (11 percent); and cancer follow-up, 108 (9 percent). Eighty-six examinations (7 percent) were performed solely for an indication of colorectal cancer screening. Twenty-two percent of patients had more than one indication for colonoscopy. Forty-five malignancies were found (3.7 percent). No cancers were found in the screening group, and two malignancies (0.7 percent) were detected in patients undergoing colonoscopy for polyp surveillance. There were eight (0.6 percent) reported major complications.


CONCLUSIONS
Colonoscopy can be performed safely in patients aged 80 years and older. However, the diagnostic yield is low, particularly in patients undergoing routine screening or surveillance examinations. Colonoscopy should for the most part be limited to elderly patients with symptoms or specific clinical findings.
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 393 Dunlap Street North, Suite 500, St. Paul, Minnesota 55104, USA.
James E
JE
Duncan
W Brian
WB
Sweeney
Judith L
JL
Trudel
Robert D
RD
Madoff
Anders F
AF
Mellgren
D000236:Adenoma / Q000175:diagnosis*; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D003113:Colonoscopy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D009780:Occult Blood; D012189:Retrospective Studies