title: Risks and Benefits of Colonoscopy in Patients 90 Years or Older, Compared With Younger Patients.
abstract: OBJECTIVE
  Although the numbers of medical procedures performed on extremely elderly patients (90 years or older, nonagenarians) are increasing, there are no data on the performance, diagnostic yield, or safety of colonoscopy for these patients. We compared the performance and safety of diagnostic colonoscopy, as well as lesions detected, in nonagenarians with patients who were 75 to 79 years old.
  
  
  METHODS
  In a retrospective study, we compared data from 76 extremely elderly patients (90 years or older) with data from 140 very elderly patients (75 to 79 years old, controls), all of whom underwent diagnostic colonoscopy from January 2010 through March 2013 at Virginia Mason Medical Center. All colonoscopies were performed by 15 endoscopists. We compared rates of colonoscopy completion, bowel preparation quality, diagnostic yield, and adverse events.
  
  
  RESULTS
  In extremely elderly patients, more colonoscopies were performed under general anesthesia, compared with controls (P < .001). When extremely elderly patients underwent colonoscopies with moderate sedation, lower doses of midazolam and fentanyl were given, compared with controls (P < .001). Colonoscopies were completed in a lower proportion of extremely elderly patients (88.2% vs. 99.3% for controls, P < .001), and these patients had a higher incidence of inadequate bowel preparation (29.7% vs. 15.0% for controls, P = .011). Colonoscopies were also associated with cardiopulmonary events in a higher proportion of extremely elderly patients (P = .006) as well as overall adverse events, compared with controls (P = .002). A higher proportion of extremely elderly patients were found to have advanced neoplasia (28.4% vs. 6.4% of controls, P < .001) as well as any neoplasia (P < .001 vs. controls). A greater percentage of extremely elderly patients also had large lesions (P = .002) and malignancies detected by histology (P < .001 vs. controls). Eleven extremely elderly patients (14.9%) were found to have cancer or high-grade dysplasia by colonoscopy.
  
  
  CONCLUSIONS
  In patients 90 years or older, diagnostic colonoscopy is associated with increased risk for incomplete procedure, inadequate bowel preparation, and adverse events. However, a large proportion of patients are found to have advanced neoplasia and cancer, compared with patients 75 to 79 years old.
authors.affiliation: Gastroenterology Division, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, South Korea; Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Cha
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Danielle
authors.initials: D
authors.lastname: La Selva
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Gluck
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ross
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Chiorean
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Johannes
authors.initials: J
authors.lastname: Koch
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington. Electronic address: ottoslin@yahoo.com.
authors.forename: Otto S
authors.initials: OS
authors.lastname: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D014768:Virginia
keywords: Colon Cancer Detection; Complication; Old Age; Risk Factor