Colonoscopy utilization and outcomes in older adults: Data from the New Hampshire Colonoscopy Registry

Abstract

Background: Colonoscopy is frequently performed in older adults, yet data on current use, and clinical outcomes of and follow-up recommendations after colonoscopy in older adults are lacking.

Methods: This was an observational study using the New Hampshire Colonoscopy Registry of adults age ≥65 years undergoing colonoscopy for screening, surveillance of prior polyps, or evaluation of symptoms. The main outcomes were clinical findings of polyps and colorectal cancer and recommendations for future colonoscopy by age.

Results: Between 2009 and 2019, there were 42,611 colonoscopies, of which 17,527 (41%) were screening, 19,025 (45%) surveillance, and 6059 (14%) for the evaluation of symptoms. Mean age was 71.1 years (SD 5.0), and 49.3% were male. The finding of colorectal cancer was rare (0.71%), with the highest incidence among diagnostic examinations (2.4%). The incidence of advanced polyps increased with patient age from 65-69 to ≥85 years for screening (7.1% to 13.6%; p = 0.05) and surveillance (9.4% to 12.0%; p < 0.001). Recommendations for future colonoscopy decreased with age and varied by findings at current colonoscopy. In patients without any significant findings, 85% aged 70-74 years, 61.9% aged 75-79 years, 39.1% aged 80-84 years, and 27.4% aged ≥85 years (p < 0.001) were told to continue colonoscopy. Among patients with advanced polyps, 97.2% aged 70-74 years, 89.6% aged 75-79 years, 78.4% aged 80-84 years, and 66.7% aged ≥85 years were told to continue colonoscopy (p < 0.001).

Conclusions: Within this comprehensive statewide registry, clinical findings during colonoscopy varied by indication and increased with age. Overall rates of finding advanced polyps and colorectal cancer are low. Older adults are frequently recommended to continue colonoscopy despite advanced age and insignificant clinical findings on current examination. These data inform the potential benefits of ongoing colonoscopy, which must be weighed with the low but known potential immediate and long-term harms of colonoscopy, including cost, psychological distress, and long lag time to benefit exceeding life expectancy.

Keywords: age; colorectal cancer screening; polyp surveillance; recommendations.

FIGURE 1

Flow diagram of colonoscopies among adults aged 65 years and older within the New Hampshire Colonoscopy Registry between 2009 and 2019 included in this study

FIGURE 2

Most advanced finding during colonoscopy by patient age and indication. *Percentages have been rounded to the nearest whole number due to space constraints. (A) Colorectal cancer. (B) Advanced polyps. (C) Nonadvanced polyps. (D) No significant findings

FIGURE 3

Recommendations to continue colonoscopy by age and most advanced finding on current colonoscopy. Of note, 42% of reports with no significant findings, 71% of reports with advanced polyps, and 85% of reports with colorectal cancer were excluded from this analysis due to a follow-up recommendation of “pending pathology”