Geriatric colonoscopy

Purpose: To review our recent experience with colonoscopy in the elderly, with particular attention to those undergoing surveillance. Methods: Analysis of a prospective database of colonoscopies performed from August 1, 1992 to May 1, 1996. Examination results were recorded by indication, which were divided into two groups - those with an independent indication such as bleeding or abnormal barium enema and those undergoing surveillance. Results: During the study period, 5,438 patients underwent 6,455 colonoscopies. Of these, 413 patients 80 years and older (range 80-96), 176 male and 237 female, received 521 colonoscopies. Bowel preparation was good in 233, fair in 250 and poor in 38. The procedure was completed in 503 (97%). In 222 colonoscopies in symptomatic patients, 74 (33.3%) had normal examinations or presence of diverticulosis, 34 (15.3%) had cancer, 102 (45.9%) had polyps, 9 (4.1%) had vascular malformations and 3 (1.4%) had other findings. In the 291 surveillance patients, 160 (55.0%) had normal examinations or the presence of diverticulum, 3 (0.8%) had cancer, 125 (43%) had polyps, 1 (0.3%) had vascular malformations and 2 (0.7%) had other findings. Of those undergoing surveillance, 58 (20.8%) had polyps and 2 had cancer proximal to the sigmoid colon and would have been missed on sigmoidoscopy. There were two complications in this group (0.7%) one perforation requiring resection and one post-polypectomy hemorrhage requiring hospitalization. Conclusions: Colonoscopy in octogenarians is safe and effective and can be completed in almost all patients. The diagnostic yield is dependent upon the indication. Given the large numbers of polyps found on routine surveillance in this age group, this practice should be continued without regard to age. Further trials are necessary to determine the optimal interval between exams.