Colonoscopy indications and findings in older adults

Year 2023, , 1307 - 1312, 29.10.2023

Oğuz Kağan Bakkaloğlu , Tuğçe Eskazan , Selçuk Candan , Yusuf Erzin , Ahmet Merih Dobrucalı

https://doi.org/10.32322/jhsm.1351555

Abstract

Aims: The share of older population is increasing globally. Colonoscopy is a frequently used diagnostic/therapeutic procedure, no study to our knowledge comprehensively examines the indications and findings of colonoscopy in geriatric population. We aimed to reveal these in older adults.
Methods: Colonoscopy procedures performed in older adults (≥65 years), which covered a 5-year period (2017-2022), were analyzed retrospectively. Indications and findings of colonoscopies were assessed. The relationship between the indications and the associated findings was also evaluated on an indication basis.
Results: In the study, 2370 colonoscopy procedures were examined. 27.8% were performed in very old (≥75 years) patients. Colonoscopy was completed in 84.3%. Colon cleansing was not optimal in approximately one-fourth. The frequency of completion of colonoscopies and optimal cleaning were similar in the very old. Iron deficiency anemia (IDA) or fecal occult blood test (FOBT) positivity and screening colonoscopy were the common indications. Regarding indications, IDA-FOBT positivity and bleeding were more frequent, screening colonoscopy, IBD and polyp control were less frequent in the very old group. Colonoscopy was reported as normal in 42.4% of the patients, while polyps (28.3%) and diverticula (17.5%) were the common findings. Among findings tumor, diverticula and solitary rectal ulcer were higher in the very old. IDA -FOBT positivity, bleeding, and colonoscopy performed due to findings of other imaging modalities were related to diagnosis of a tumor.
Conclusion: In this study, we presented the indications and results of colonoscopy in a large number of older patients. The main indications for colonoscopy can be listed as IDA-FOBT positivity, screening colonoscopy and control of previous polyp-tumor. Near one of two colonoscopies were found to be normal, polyps and diverticula were the major pathologies in the rest. It should be emphasized that IDA -FOBT positivity, bleeding, and findings of other imaging modalities were related to tumor in colonoscopy.

Keywords

Colonoscopy, elderly, geriatric, colorectal carcinoma

Supporting Institution

Yok

Project Number

yok

Thanks

-

References

• Organisation WH. Ageing and health. Accessed 17.06.2023, 2023. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
• Dartigues JF, Le Bourdonnec K, Tabue-Teguo M, et al. Co-occurrence of geriatric syndromes and diseases in the general population: assessment of the dimensions of aging. J Nutr Health Aging. 2022;26(1):37-45. doi:10.1007/s12603-021-1722-3
• Stevens T, Burke CA. Colonoscopy screening in the elderly: when to stop? Am J Gastroenterol. 2003;98(8):1881-1885. doi:10.1111/j.1572-0241.2003.07576.x
• Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116(3):458-479. doi:10.14309/ajg.0000000000001122
• Hafner M. Conventional colonoscopy: technique, indications, limits. Eur J Radiol. 2007;61(3):409-414. doi:10.1016/j.ejrad.2006.07.034
• Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14(2):89-103. doi:10.5114/pg.2018.81072
• TUIK. Life Tables, 2019-2021. TUIK. Accessed 23.09.2023, 2023. https://data.tuik.gov.tr/Bulten/Index?p=Life Tables-2019-2021-45592&dil=2#:~:text=In%20Türkiye%2C%20life%20expectancy%20at,80.5%20in%20the%20same%20period.
• Au AM, Chan SC, Yip HM, et al. Age-Friendliness and Life Satisfaction of Young-Old and Old-Old in Hong Kong. Curr Gerontol Geriatr Res. 2017;2017:6215917.
• Aljarallah B, Alshammari B. Colonoscopy completion rates and reasons for incompletion. Int J Health Sci (Qassim). 2011;5(2):102-107.
• Church JM. Complete colonoscopy: how often? And if not, why not? Am J Gastroenterol. 1994;89(4):556-560.
• Triantafyllou K, Sioulas AD, Kalli T, et al. Optimized sedation improves colonoscopy quality long-term. Gastroenterol Res Pract. 2015;2015:195093. doi:10.1155/2015/195093
• Cardin F, Minicuci N, Andreotti A, et al. Maximizing the general success of cecal intubation during propofol sedation in a multi-endoscopist academic centre. BMC Gastroenterol. 2010;10:123. doi:10.1186/1471-230X-10-123
• Manko M, Bello AK, Mohammed MF, et al. Colonoscopy in Zaria: Indications and findings. Niger J Clin Pract. 2022;25(9):1580-1583. doi:10.4103/njcp.njcp_150_22
• Houissa F, Kchir H, Bouzaidi S, et al. Colonoscopy in elderly: feasibility, tolerance and indications: about 901 cases. Tunis Med. Nov 2011;89(11):848-852.
• Wexner SD, Garbus JE, Singh JJ, Group SCSO. A prospective analysis of 13,580 colonoscopies. reevaluation of credentialing guidelines. Surg Endosc. 2001;15(3):251-261. doi:10.1007/s004640080147
• Schiller LR, Pardi DS, Spiller R, et al. Gastro 2013 APDW/WCOG Shanghai working party report: chronic diarrhea: definition, classification, diagnosis. J Gastroenterol Hepatol. 2014;29(1):6-25. doi:10.1111/jgh.12392
• Schiller LR. Chronic diarrhea evaluation in the elderly: IBS or something else? Curr Gastroenterol Rep. 2019;21(9):45. doi:10.1007/s11894-019-0714-5
• Narayanan SP, Anderson B, Bharucha AE. Sex- and gender-related differences in common functional gastroenterologic disorders. Mayo Clin Proc. 2021;96(4):1071-1089. doi:10.1016/j.mayocp.2020.10.004
• Schmuck R, Gerken M, Teegen EM, et al. Gender comparison of clinical, histopathological, therapeutic and outcome factors in 185,967 colon cancer patients. Langenbecks Arch Surg. 2020;405(1):71-80. doi:10.1007/s00423-019-01850-6
• Deb B, Prichard DO, Bharucha AE. Constipation and fecal incontinence in the elderly. Curr Gastroenterol Rep. 2020;22(11):54. doi:10.1007/s11894-020-00791-1
• Alexander-Williams J. Solitary-ulcer syndrome of the rectum. Its association with occult rectal prolapse. Lancet. 1977;1(8004):170-171. doi:10.1016/s0140-6736(77)91766-4
• Akhtar AJ. Lower gastrointestinal bleeding in elderly patients. J Am Med Dir Assoc. 2003;4(6):320-322. doi:10.1097/01.JAM. 0000094061.76412.75
• Gokden Y, Ozulker F, Ozulker T. Prevalence and clinical significance of incidental focal (18)F-FDG uptake in colon on PET/CT imaging. Mol Imaging Radionucl Ther. 2022;31(2):96-103. doi:10.4274/mirt.galenos.2022.38247
• Pickhardt PJ. Noninvasive radiologic imaging of the large intestine: a valuable complement to optical colonoscopy. Curr Opin Gastroenterol. 2010;26(1):61-68. doi:10.1097/MOG.0b013e328332b835