COLONOSCOPY IN THE VERY ELDERLY: SHOULD WE JUST UTILISE THE CT SCANNER?

Aims Lower gastrointestinal symptoms are common in the very elderly; however, colonoscopy is not always appropriate due to choice, fitness and/or periprocedural risk. In a cohort where the vast majority already undergo cross-sectional imaging, computed tomographic colonography (CTC) could become the first-line test. We analysed a very elderly cohort undergoing colonoscopy to assess the diagnostic yield and eventual treatment.

Methods We performed a retrospective analysis of 122 elderly patients aged≥85, who underwent colonoscopy in 2020 at Chase Farm Hospital, London. Patient demographics, indication, diagnosis and management were determined from endoscopy databases.

Results The average age was 87(85-100) with 57% having≥3 major co-morbidities. Colorectal cancer (CRC) was found in 22(18%) patients and polyps≥6 mm in 38(31%). Among those with CRC eight underwent curative surgery, three declined, three had chemo/radiotherapy and eight received best supportive care. All cause one-year mortality was 7.4%. CT was completed in 64% before endoscopy. Of the 36% who did not undergo imaging two were diagnosed with cancer and ten had polyps≥6 mm.

Conclusions There was a high prevalence of CRC and large polyps, but minimal patients underwent definitive treatment. In addition, in a cohort with a 7.4% 1-year mortality the risk/benefit of removing diminutive polyps unlikely to develop into clinically significant tumours needs to be questioned. We should consider a CTC-first approach in this age group to enable better risk stratification and discussion about colonoscopic intervention to prevent unnecessary, high-risk procedures, which would have prevented over a quarter of colonoscopies in our cohort

Publication History

Article published online:
14 April 2022