Skip to main content
SpringerLink
Log in

Colonoscopy in the Elderly: Low Risk, Low Yield in Asymptomatic Patients

  • Published:
Diseases of the Colon & Rectum

Purpose

Current colonoscopy guidelines do not address the issue of when to stop performing screening and surveillance colonoscopy in the elderly. We reviewed our experience and results of colonoscopy in patients aged 80 years and older to assess the risks and diagnostic yield in this population.

Methods

We reviewed retrospectively the endoscopic and pathologic reports from consecutive colonoscopies performed on patients aged 80 years and older at a single, high-volume endoscopy center between August 1999 and May 2003. Patient characteristics, indications for examination, findings at colonoscopy, and complications were recorded and analyzed.

Results

A total of1,199 colonoscopic examinations were performed on 1,112 patients. Average age was 83.1 (range, 80–100) years. Male:female distribution was 1:1.7. Leading exclusive indications for colonoscopy included: polyp surveillance, 227 (19 percent); altered bowel habits, 168 (14 percent); iron-deficiency anemia, 132 (11 percent); and cancer follow-up, 108 (9 percent). Eighty-six examinations (7 percent) were performed solely for an indication of colorectal cancer screening. Twenty-two percent of patients had more than one indication for colonoscopy. Forty-five malignancies were found (3.7 percent). No cancers were found in the screening group, and two malignancies (0.7 percent) were detected in patients undergoing colonoscopy for polyp surveillance. There were eight (0.6 percent) reported major complications.

Conclusions

Colonoscopy can be performed safely in patients aged 80 years and older. However, the diagnostic yield is low, particularly in patients undergoing routine screening or surveillance examinations. Colonoscopy should for the most part be limited to elderly patients with symptoms or specific clinical findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Agency for Health Care Policy and Research. Colorectal Cancer Screening. Technical review 1; 1998. Rockville, MD, AHCPR publication No. 98-0033

  2. InstitutionalAuthorNameNational Comprehensive Cancer Network (1999) ArticleTitleNCCN colorectal cancer screening practice guidelines Oncology 13 152–179

    Google Scholar 

  3. RA Smith AC Eschenbach Particlevon R Wender et al. (2001) ArticleTitleAmerican Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers CA Cancer J Clin 51 38–75 Occurrence Handle1:STN:280:DC%2BD3MrjtFGisw%3D%3D Occurrence Handle11577479 Occurrence Handle10.3322/canjclin.51.1.38

    Article  CAS  PubMed  Google Scholar 

  4. DK Rex DA Johnson DA Lieberman RW Burt A Sonnenberg (2000) ArticleTitleColorectal cancer screening 2000: screening recommendations of the American College of Gastroenterology Am J Gastroenterol 95 868–877 Occurrence Handle1:STN:280:DC%2BD3c3isFSjsw%3D%3D Occurrence Handle10763931

    CAS  PubMed  Google Scholar 

  5. DM Mladen MP Dragoslav Z Sanja B Bozidar D Snezana (2003) ArticleTitleProblems in screening colorectal cancer in the elderly World J Gastroenterol 9 2335–2337 Occurrence Handle14562405

    PubMed  Google Scholar 

  6. K Miller JD Waye (2002) ArticleTitleColorectal polyps in the elderly: what should be done? Drugs Aging 19 393–404 Occurrence Handle10.2165/00002512-200219060-00001 Occurrence Handle12149048

    Article  PubMed  Google Scholar 

  7. P Limpert WE Longo PR Kelemen et al. (2003) ArticleTitleColon and rectal cancer in the elderly. High incidence of asymptomatic disease, less surgical emergencies, and a favorable short-term outcome Crit Rev Oncol Hematol 48 159–163 Occurrence Handle14607379

    PubMed  Google Scholar 

  8. T Stevens CA Burke (2003) ArticleTitleColonoscopy screening in the elderly: when to stop? Am J Gastroenterol 98 1881–1885 Occurrence Handle10.1111/j.1572-0241.2003.07576.x Occurrence Handle12907348

    Article  PubMed  Google Scholar 

  9. DA Lieberman DG Weiss JH Bond DJ Ahnen H Garewal G Chejfec (2000) ArticleTitleUse of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380 N Engl J Med 343 162–168 Occurrence Handle10.1056/NEJM200007203430301 Occurrence Handle1:STN:280:DC%2BD3czksVemsA%3D%3D Occurrence Handle10900274

    Article  CAS  PubMed  Google Scholar 

  10. GS Cooper Z Yuan S Landefeld JF Johanson AA Rimm (1995) ArticleTitleA national population-based study of incidence of colorectal cancer and age. Implications for screening in older Americans Cancer 75 775–781 Occurrence Handle1:STN:280:ByqC38bgtlY%3D Occurrence Handle7828127

    CAS  PubMed  Google Scholar 

  11. Miller BA, Ries LA, Hankey BF. SEER cancer statistics review: 1973–1990. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health; 1993 NIH Publication No. 93-2789

  12. SH Itzkowitz (1996) ArticleTitleGastrointestinal adenomatous polyps Semin Gastrointest Dis 7 105–116 Occurrence Handle1:STN:280:BymB2s7itlY%3D Occurrence Handle8705258

    CAS  PubMed  Google Scholar 

  13. MJ O'Brien SJ Winawer AG Zauber et al. (1990) ArticleTitleThe National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas Gastroenterology 98 371–379 Occurrence Handle2403953

    PubMed  Google Scholar 

  14. JA Lagares-Garcia S Kurek B Collier et al. (2001) ArticleTitleColonoscopy in octogenarians and older patients Surg Endosc 15 262–265 Occurrence Handle10.1007/s004640000339 Occurrence Handle1:STN:280:DC%2BD38%2FgvFyjtg%3D%3D Occurrence Handle11344425

    Article  CAS  PubMed  Google Scholar 

  15. A Kirchgatterer D Hubner G Aschl M Hinterreiter B Stadler P Knoflach (2002) ArticleTitleColonoscopy and sigmoidoscopy in patients aged eighty years or older Z Gastroenterol 40 951–956 Occurrence Handle10.1055/s-2002-36157 Occurrence Handle1:STN:280:DC%2BD3s%2Fht1WltQ%3D%3D Occurrence Handle12518261

    Article  CAS  PubMed  Google Scholar 

  16. TC Sardinha JJ Nogueras ED Ehrenpreis et al. (1999) ArticleTitleColonoscopy in octogenarians: a review of 428 cases Int J Colorectal Dis 14 172–176 Occurrence Handle10.1007/s003840050205 Occurrence Handle1:STN:280:DyaK1MzptFyhtA%3D%3D Occurrence Handle10460909

    Article  CAS  PubMed  Google Scholar 

  17. T Ure K Dhghan AM Vernava Suffix3rd WE Longo CA Andrus GL Daniel (1995) ArticleTitleColonoscopy in the elderly. Low risk, high yield Surg Endosc 9 505–508 Occurrence Handle1:STN:280:ByqH3cnotFA%3D Occurrence Handle7676371

    CAS  PubMed  Google Scholar 

  18. AJ Clark D Stockton A Elder RG Wilson MG Dunlop (2004) ArticleTitleAssessment of outcomes after colorectal cancer resection in the elderly as a rationale for screening and early detection Br J Surg 91 1345–1351 Occurrence Handle10.1002/bjs.4601 Occurrence Handle1:STN:280:DC%2BD2cvpsFehtA%3D%3D Occurrence Handle15376202

    Article  CAS  PubMed  Google Scholar 

  19. J David F Totta M Shaukat et al. (2000) ArticleTitleAt what age is it appropriate to stop screening flexible sigmoidoscopy [abstract]. Am J Gastroenterol 95 2531 Occurrence Handle10.1111/j.1572-0241.2000.02775.x

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Jeffery Rank, Dr. James Pries, Mr. Paul Stone, and Ms. Sandy Young of Minnesota Gastroenterology, P.A. for their assistance in collection of data.

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 393 Dunlap Street North, Suite 500, St. Paul, Minnesota, 55104, USA

    James E. Duncan M.D., W. Brian Sweeney M.D., W. Brian Sweeney M.D., Judith L. Trudel M.D., Robert D. Madoff M.D. & Anders F. Mellgren M.D., Ph.D.

Authors
  1. James E. Duncan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Brian Sweeney M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Judith L. Trudel M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert D. Madoff M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anders F. Mellgren M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Brian Sweeney M.D..

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, May 2 to 5, 2005.

About this article

Cite this article

Duncan, J.E., Sweeney, W.B., Trudel, J.L. et al. Colonoscopy in the Elderly: Low Risk, Low Yield in Asymptomatic Patients. Dis Colon Rectum 49, 646–651 (2006). https://doi.org/10.1007/s10350-005-0306-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-005-0306-3

Key words

Search

Navigation