Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits

Abstract

Many diagnostic and screening colonoscopies are performed on very elderly patients. Although colonoscopic yield increases with age, the potential benefits in such patients decrease because of shorter life expectancy and more frequent comorbidities. Colonoscopy in very elderly patients carries a greater risk of complications and morbidity than in younger patients, and is associated with lower completion rates and higher likelihood of poor bowel preparation. Thus, screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks and patient preferences. On the other hand, diagnostic and therapeutic colonoscopy are more likely to benefit even very elderly patients, and in most cases should be performed if indicated.

Keywords: Bowel preparation; Colon cancer; Colon polyp; Colonoscopy; Complications; Elderly; Screening; Surveillance; Yield.

Figure 1

Published studies reporting rates of poor or inadequate bowel preparation for colonoscopy in elderly patients and non-elderly controls: Chatrenet[13], Duncan[11], George[53], Karajeh[15], Lukens[31], Ma[19] and Syn[9].