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The efficacy and safety of colonoscopy in nonagenarians: A multicenter study

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Abstract

Introduction

The number of colonoscopy (CS) for the elderly is increasing. There are only a few reports focusing on CS among the very elderly aged ≥ 90-y. We aimed to analyze the efficacy of CS and of colorectal cancer (CRC) for patients aged ≥ 90-y.

Methods

We retrospectively analyzed consecutive patients aged ≥ 90-y receiving CS at eight institutions from October 2016 to September 2017. Bowel preparation, complications, and endoscopic diagnosis were analyzed. The non-elderly group aged between 50-y and 64-y and elderly group aged between 65-y and 79-y were compared to very-elderly group aged ≥ 90-y. Through propensity score matching of sex and CS indications (symptomatic or asymptomatic), the number of CRC and the treatment in each group were analyzed.

Results

We analyzed 125 patients receiving 154 colonoscopies (0.9%) in the very-elderly group from among 16,968 cases. Among 92 cases who received bowel-cleansing solution, good preparations were achieved in 94.5%. The rate of CS-related complications was 1.3% (2/154). The rate of CRC in the very-elderly group was 27.2% (34/125), higher than the non-elderly group (7.2%, 9/125, p < 0.01) and elderly group (8.8%, 11/125, p < 0.01). Therapeutic interventions for CRC in the very-elderly group were performed in 73.5% (24/34) patients. The mean survival of 12 patients with CRC resection was 788 days.

Conclusions

CS could be performed safely for the very elderly aged ≥ 90-y with careful considerations. CRC was confirmed to be more frequent in this group with over 70% of patients receiving appropriate therapeutic intervention.

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References

  1. WHO. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 1 Mar 2020.

  2. Statistics Bureau, Ministry of Internal Affairs and Communications. http://www.stat.go.jp/english/index.html. Accessed 1 Mar 2020.

  3. Arora A, Singh P. Colonoscopy in patients 80 years of age and older is safe, with high success rate and diagnostic yield. Gastrointest Endosc. 2004;60:408–13.

    Article  Google Scholar 

  4. Duncan JE, Sweeney WB, Trudel JL, Madoff RD,  Mellgren AF. Colonoscopy in the elderly: low risk, low yield in asymptomatic patients. Dis Colon Rectum. 2006;49:646–51.

    Article  Google Scholar 

  5. Syn WK, Tandon U, Ahmed MM. Colonoscopy in the very elderly is safe and worthwhile. Age Ageing. 2005;34:510–3.

    Article  Google Scholar 

  6. Bat L, Pines A, Shemesh E, et al. Colonoscopy in patients aged 80 years or older and its contribution to the evaluation of rectal bleeding. Postgrad Med J. 1992;68:355–8.

  7. Clarke GA, Jacobson BC, Hammett RJ, Carr-Locke DL. The indications, utilization and safety of gastrointestinal endoscopy in an extremely elderly patient cohort. Endoscopy. 2001;33:580–4.

    Article  CAS  Google Scholar 

  8. Day LW, Kwon A, Inadomi JM, Walter LC,  Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc. 2011;74:885–96.

    Article  Google Scholar 

  9. Yoong KK, Heymann T. Colonoscopy in the very old: why bother? Postgrad Med J. 2005;81:196–7.

    Article  CAS  Google Scholar 

  10. Lukens FJ, Loeb DS, Machicao VI, Achem SR, Picco MF. Colonoscopy in octogenarians: a prospective outpatient study. Am J Gastroenterol. 2002;97:1722–5.

    Article  Google Scholar 

  11. Cardin F, Andreotti A, Martella B, Terranova C,  Militello C. Current practice in colonoscopy in the elderly. Aging Clin Exp Res. 2012;24:9–13.

    PubMed  Google Scholar 

  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  Google Scholar 

  13. ASGE Standards of Practice Committee, Saltzman JR, Cash BD, et al. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015;81:781–94.

  14. Sobani ZA, Yunina D, Abbasi A, et al. Endoscopic retrograde cholangiopancreatography in nonagenarian patients: is it really safe? Clin Endosc. 2018;51:375–80.

  15. Day LW, Lin L, Somsouk M. Adverse events in older patients undergoing ERCP: a systematic review and meta-analysis. Endosc Int Open. 2014;2:E28–36.

  16. Warren JL, Klabunde CN, Mariotto AB, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150:849–57.

  17. Lagares-Garcia JA, Kurek S, Collier B, et al. Colonoscopy in octogenarians and older patients. Surg Endosc. 2001;15:262–5.

    Article  CAS  Google Scholar 

  18. Ko CW, Riffle S, Michaels L, et al. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. Clin Gastroenterol Hepatol. 2010;8:166–73.

    Article  Google Scholar 

  19. Ma WT, Mahadeva S, Kunanayagam S, Poi PJH, Goh KL. Colonoscopy in elderly Asians: a prospective evaluation in routine clinical practice. J Dig Dis. 2007;8:77–81.

  20. Karajeh MA, Sanders DS, Hurlstone DP. Colonoscopy in elderly people is a safe procedure with a high diagnostic yield: a prospective comparative study of 2000 patients. Endoscopy. 2006;38:226–30.

  21. Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc. 2009;69:654–64.

    Article  Google Scholar 

  22. Cha JM, Kozarek RA, La Selva D, et al. Risks and benefits of colonoscopy in patients 90 years or older, compared with younger patients. Clin Gastroenterol Hepatol. 2016;14:80–6.

    Article  Google Scholar 

  23. Yoshida N, Naito Y, Murakami T, et al. Safety and efficacy of a same-day low-volume 1 L PEG bowel preparation in colonoscopy for the elderly people and people with renal dysfunction. Dig Dis Sci. 2016;61:3229–35.

  24. Tsutsumi S, Fukushima H, Osaki K, Kuwano H. Feasibility of colonoscopy in patients 80 years of age and older. Hepatogastroenterology. 2007;54:1959–61.

  25. Okamoto M, Shiratori Y, Yamaji Y, et al. Relationship between age and site of colorectal cancer based on colonoscopy findings. Gastrointest Endosc. 2002;55:548–51.

  26. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2017;153:307–23.

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Acknowledgments

The authors would like to thank Dr. Kenji Itani, Dr. Takashi Shimomura in Nishijin Hospital and we also thank Dr. Yuri Tomita, Dr. Hikaru Hashimoto, Dr. Satoshi Sugino, Dr. Yasutaka Morimoto, Dr. Munehiro Kugai, Dr. Kouhei Fukumoto, Dr. Hiroyuki Yoriki, and Dr. Takayuki Motoyoshi, who were members of Kyoto Improvement of Colonoscopy Seminar for their assistance with this study.

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Authors and Affiliations

  1. Department of Gastroenterology, Nishijin Hospital, Kyoto, Japan

    Yoshikazu Inagaki & Kyoichi Kassai

  2. Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Naohisa Yoshida, Ritsu Yasuda, Ken Inoue, Ryohei Hirose, Osamu Dohi & Yoshito Itoh

  3. Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan

    Daisuke Hasegawa

  4. Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan

    Takashi Okuda & Yutaka Inada

  5. Department of Gastroenterology, Kyoto Kujyo Hospital, Kyoto, Japan

    Kotaro Okuda

  6. Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan

    Kiyoshi Ogiso

  7. Department of Gastroenterology, Saiseikai Kyoto Hospital, Kyoto, Japan

    Akira Tomie

  8. Department of Gastroenterology, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan

    Koichi Soga

  9. Department of Gastroenterology, Japan Community Health Care Organization, Kyoto Kuramaguchi Medical Center, Kyoto, Japan

    Takaaki Murakami

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  1. Yoshikazu Inagaki
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  2. Naohisa Yoshida
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  3. Daisuke Hasegawa
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  4. Kyoichi Kassai
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  5. Ritsu Yasuda
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  6. Ken Inoue
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  9. Takashi Okuda
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  10. Yutaka Inada
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  11. Kotaro Okuda
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  12. Kiyoshi Ogiso
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  13. Akira Tomie
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  14. Koichi Soga
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  15. Takaaki Murakami
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  16. Yoshito Itoh
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Corresponding author

Correspondence to Naohisa Yoshida.

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Conflict of interest

YI, NY, DH, KK, RY, KI, RH, OD, TO, YI, KO, KO, AT, KS, TM, and YI declare that they have no conflict of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com. The study was conducted after obtaining proper ethical clearance from the representative institutional ethics committee, Nishijin Hospital.

This study was a retrospective setting and an opt-out was performed in the representative facility.

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Inagaki, Y., Yoshida, N., Hasegawa, D. et al. The efficacy and safety of colonoscopy in nonagenarians: A multicenter study. Indian J Gastroenterol 39, 557–564 (2020). https://doi.org/10.1007/s12664-020-01066-3

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  • DOI: https://doi.org/10.1007/s12664-020-01066-3

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