Introduction Colonoscopy is accepted as the gold standard imaging modality of the colon for investigation of colonic symptoms including altered bowel habit, anaemia, rectal bleeding and for the detection of colorectal cancer. The incidence of pathological findings within the colon in particular colorectal cancer increases with age, and the detection of these cancers comprise a major role of colonoscopy in the elderly population. However, colonoscopy in the elderly may be more difficult, as elderly patients are more likely than younger patients to have poor bowel preparations. Furthermore, complications of colonoscopy, in particular cardiovascular, maybe higher in this age group. To date no data exist in colonoscopies performed in those over 90 years of age.
Methods The aim of the study was to assess the diagnostic yield and safety of colonoscopy in the very elderly patients over 90 years of age. A single centre, retrospective analysis of patients over 90 years of age in a district general hospital from north London was performed. The patients were identified using the Unisoft Endoscopy reporting software over a period between June 2006 to March 2013. Data obtained during the study period was scrutinised for indication, sedation administered, quality of bowel prep, findings of procedure, and complications.
Results During the study period, 66 colonoscopies were performed out of a total 666 endoscopic procedures in patients over 90. The indications for colonoscopy included : abnormal CT scan 5/66, altered bowel habit in 17/66, anaemia 24/66, rectal bleeding 15/66, colonic obstruction 3/66, previous polyp/colon cancer 4/66, abdominal mass 1/66. 18/66 patients had poor bowel prep. Findings included normal in 18/66, colo-rectal cancer in 13/66 patients, colonic polyps in 5/66, ischaemic colitis 1/66, angiodysplasia 2/66, diverticulosis in 31/66. Sedation administered varied from none in 4/66, to midazolam 5 mg + pethidine 50 mg in 2/66. There were no complications from the colonoscopy in 66 patients within the study.
Conclusion The data from this study demonstrates that colonoscopies can be performed safely in patients over 90 years of age with no increase in procedure related mortality. Despite poor bowel preparation encountered in 28%, the diagnostic yield of pathology in patients over 90 having colonoscopy was very high with an abnormality in 48/66 (72% in this study). Colonoscopy in the very elderly is very safe and worthwhile and clinicians should not be reluctant in referring those over 90 years of age for colonoscopic examination.
Disclosure of Interest None Declared.
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