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Agaciak M, Wassie MM, Simpson K, Cock C, Bampton P, Fraser R, Symonds EL. Surveillance colonoscopy findings in asymptomatic participants over 75 years of age. JGH Open 2024; 8:e13071. [PMID: 38699472 PMCID: PMC11062249 DOI: 10.1002/jgh3.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/06/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
Background and Aim Surveillance colonoscopy for colorectal cancer (CRC) is generally not recommended beyond 75 years of age. The study determined incidence and predictors of advanced adenoma and CRC in older individuals undergoing surveillance colonoscopy. Methods This was a retrospective cohort study of asymptomatic older participants (≥75 years), enrolled in a South Australian CRC surveillance program who underwent colonoscopy (2015-2020). Clinical records were extracted for demographics, personal or family history of CRC, comorbidities, polypharmacy, and colonoscopy findings. The associations between clinical variables and advanced adenoma or CRC at surveillance were assessed with multivariable Poisson regression analysis. Results Totally 698 surveillance colonoscopies were analyzed from 574 participants aged 75-91 years (55.6% male). The incidence of CRC was 1.6% (11/698), while 37.9% (260/698) of procedures had advanced adenoma detected. Previous CRC (incidence rate ratio [IRR] 5.9, 95% CI 1.5-22.5), age ≥85 years (IRR 5.8, 95% CI 1.6-20.1) and active smoking (IRR 4.9, 95% CI 1.0-24.4) were independently associated with CRC diagnosis, while advanced adenoma at immediately preceding colonoscopy (IRR 1.6, 95% CI 1.3-2.0) and polypharmacy (IRR 1.2, 95% CI 1.0-1.5) were associated with advanced adenoma at surveillance colonoscopy in asymptomatic older participants (≥75 years). Conclusion Advanced neoplasia was found in more than one third of the surveillance procedures completed in this cohort. Continuation of surveillance beyond age 75 yeasrs may be considered in participants who have previous CRC or are active smokers (provided they are fit to undergo colonoscopy). In other cases, such as past advanced adenoma only, the need for ongoing surveillance should be considered alongside participant preference and health status.
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Affiliation(s)
- Madelyn Agaciak
- Department of Medicine, College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Molla M Wassie
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
| | - Kalindra Simpson
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Charles Cock
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Peter Bampton
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Robert Fraser
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Erin L Symonds
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
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Xiao AY, Anandabaskaran S, Ow MM. Risk Factors Associated with Colorectal Cancer in Octogenarians Can Help Stratify the Need for Colonoscopy. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0041-1742256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Objective Colonoscopy is increasingly performed in octogenarians for the detection of colorectal cancer (CRC), but its benefits may be outweighed by its risks. The aim of the present study was to identify the risk factors for CRC in octogenarians presenting for colonoscopy to help stratify the need for this procedure.
Methods A retrospective analysis of 434 patients aged ≥ 80 years referred for a colonoscopy between January 2018 and December 2019. Comparisons were made between those with and without CRC and advanced adenoma (AA). The primary endpoint was to identify the clinical variables predictive of CRC and AA, and the secondary endpoints were complications and death 30 days after the procedure.
Results Colonoscopy was performed in 434 octogenarians, predominantly for symptoms, with CRC in 65 (15.0%) patients. Iron deficiency was associated with a higher risk of having CRC identified on colonoscopy (odds ratio [OR]: 2.33; 95% confidence interval [95%CI] = 1.36–4.00), but not symptoms such as bleeding, weight loss, or diarrhea. A colonoscopy in the last 10 years was protective, with a lower risk of CRC (OR: 0.45; 95%CI = 0.22–0.93). Patients with both normal iron stores and a colonoscopy within 10 years had a 92.5% chance of not having CRC. No variables were predictive of AA. Patients with complications, including death, were older and more likely to have underlying cardiorespiratory disease.
Conclusion Iron status and colonoscopy within 10 years can be used to predict the risk of CRC in octogenarians. Those with low predicted risk, especially if older and with cardiorespiratory disease, should be considered for non-invasive tests, such as computed tomography (CT) colonography, over colonoscopy.
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Affiliation(s)
- Amy Y. Xiao
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Maggie M. Ow
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Department of Gastroenterology and Hepatology, Auckland City Hospital, Auckland, New Zealand
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Sapci I, Guyton K, Church J, Liska D, Gorgun E, Steele SR, Valente MA. Advanced age alone should not preclude surveillance colonoscopy in the octogenarian and older population. Am J Surg 2021; 223:510-512. [PMID: 34916038 DOI: 10.1016/j.amjsurg.2021.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although the risk of colorectal cancer increases with advancing age, there remains a lack of guidelines for surveillance colonoscopy in the octogenarian and older population. Our objective is to document the diagnostic yield of surveillance colonoscopies, and to analyze adenoma characteristics, complications, and short-term survival in asymptomatic octogenarian and older patients undergoing adenoma surveillance colonoscopy. METHODS Surveillance colonoscopies performed at a tertiary level hospital colorectal surgery department between January 2010 and September 2018 were queried from a prospectively maintained institutional colonoscopy database. Patients 80 years old or older undergoing routine surveillance colonoscopy after having had an adenoma or advanced adenoma diagnosed on a prior exam were included in the study. RESULTS 604 patients were included in the study with a median age of 82 and 43% were female. Median follow-up was 52 months (range 2-110), with 511(85%) patients alive at their last available follow-up. Overall, 292 patients had at least one had adenomatous lesion and 105 (17.4%) patients had advanced adenomas. Increasing age was not associated with increased rate of sessile serrated lesions (p = 0.2) however, there was an association between increasing age and advanced adenoma rates (p = 0.01). Advanced adenomas were more commonly found to be right-sided (p = 0.02). Four asymptomatic patients were diagnosed with cancer at surveillance (0.6%). CONCLUSIONS Patients 80 years of age or older with a previous history of colorectal adenoma(s) may have a high risk of future advanced lesions and can be considered to undergo surveillance colonoscopy.
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Affiliation(s)
- Ipek Sapci
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kristina Guyton
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Church
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Liska
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael A Valente
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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Colorectal cancer screening in hospitalized patients: results from the Nationwide Inpatient Sample. Eur J Cancer Prev 2020; 28:413-419. [PMID: 30444754 DOI: 10.1097/cej.0000000000000488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Colorectal cancer (CRC) is preventable with regular screening. This study aims to determine estimates and predictors of inpatient CRC screening during hospitalization in the USA. This nationwide population-based study utilized data from the National Inpatient Sample database from 2005 to 2014 to examine rates of CRC screening among hospitalized patients. There were 6470 inpatient CRC screening nationwide from 129 645 394 inpatient hospitalizations. Multivariable analysis showed that higher rates of inpatient CRC screening were associated with: females compared to males [odds ratio (OR): 0.87; 95% confidence interval (CI): 0.78-0.97]; 50-59 years age group compared to 70-79 years (OR: 0.76; 95% CI: 0.62-0.94) and more than 80 years (OR: 0.47; 95% CI: 0.35-0.64); Charlson Comorbidity Index score of 0 compared to scores of 1-2 (OR: 0.79; 95% CI: 0.64-0.98), 3-4 (OR: 0.61; 95% CI: 0.49-0.76), more than 5 (OR: 0.61; 95% CI: 0.47-0.79); rural hospitals rather than urban teaching hospital (OR: 0.50; 95% CI: 0.39-0.63) and urban nonteaching hospitals (OR: 0.64; 95% CI: 0.49-0.82); hospitals in the Midwest region (OR: 1.56; 95% CI: 1.14-2.12) compared to the Northeast region; recent years of 2011/2012 (OR: 1.89; 95% CI: 1.44-2.49) and 2013/2014 (OR: 2.70; 95% CI: 2.14-3.41) compared to the period 2005/2006. The CRC screening rate among hospitalized patients admitted in US hospitals is low. There were no association of differences in racial, household income or health insurance status with inpatient CRC screening. Noninvasive screening methods in hospitalized patients like stool-based fecal immunochemical test provide a unique method of increasing cancer screening rates.
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Tanaka H, Oka S, Tanaka S, Inagaki K, Okamoto Y, Matsumoto K, Boda K, Yamashita K, Sumimoto K, Ninomiya Y, Chayama K. Can surveillance colonoscopy be discontinued in an elderly population with diminutive polyps? J Anus Rectum Colon 2019; 3:128-135. [PMID: 31583328 PMCID: PMC6774739 DOI: 10.23922/jarc.2018-042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/28/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Surveillance colonoscopy after endoscopic resection (ER) for adenomatous polyps reduces the incidence and mortality of colorectal cancer (CRC). However, its significance in the elderly population is uncertain. The study aimed to determine whether surveillance colonoscopy should be discontinued in the elderly population. METHODS We enrolled 105 patients who underwent baseline colonoscopy between January 2004 and December 2009 and were subsequently followed-up over 5 years in our institution. All had diminutive colorectal polyps and were aged <80 years at baseline colonoscopy and ≥80 years at follow-up in May 2018. Patients who had undergone colectomy or who had inflammatory bowel disease, familial adenomatous polyposis, Lynch syndrome, and no diminutive polyps were excluded. The cumulative incidence of the target lesion was evaluated. Histopathological diagnoses included low-grade dysplasia (LGD), high-grade dysplasia (HGD), and carcinoma. RESULTS The target lesion was detected in 15% (16/105) of the patients. There was no invasive carcinoma; however, two HGDs were detected. There were three lesions that had increased from previously detected diminutive lesions, all of which were LGDs. There were no target lesions detected after 84 years of age, and the cumulative incidence was 0.20. The cumulative incidence was significantly higher in the group with HGD than in the group with no target lesions at baseline colonoscopy. There was no HGD after age 79 years, and the cumulative incidence was 0.019. CONCLUSION Surveillance colonoscopy for patients with diminutive polyps may be discontinued after age 79 years.
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Affiliation(s)
- Hidenori Tanaka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Katsuaki Inagaki
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Okamoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenta Matsumoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuki Boda
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kyoku Sumimoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Ninomiya
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Cha JM. Would you recommend screening colonoscopy for the very elderly? Intest Res 2014; 12:275-80. [PMID: 25374492 PMCID: PMC4214953 DOI: 10.5217/ir.2014.12.4.275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 12/31/2022] Open
Abstract
Life expectancy in Korea has increased, and the number of screening colonoscopies in the elderly has also dramatically increased. The net benefit of colonoscopy in the very elderly (≥80 years of age as defined by the World Health Organization) may be reduced because of the competing risk of mortality due to other diseases. Therefore, the decision to perform screening colonoscopy may be more complex in this age group. As the potential increase in life expectancy due to screening colonoscopy is significantly reduced in the very elderly, this procedure should be limited to those among the very elderly who have substantial life expectancies. Furthermore, considering the common major complications associated with colonoscopy, poor bowel preparation, and the possibility of incomplete colonoscopies in the very elderly, the performance of screening colonoscopy in the very elderly may not be an ideal recommendation. In terms of providing the greatest benefit to the most number of people, patients with the highest potential gain in terms of life expectancy, relative to the diagnostic yield, should be targeted for colonoscopy screening. This review addresses the unique considerations regarding screening colonoscopy in the very elderly and the individualized approach, which involves the weighing of the risks and benefits for each individual with consideration of their overall health status.
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Affiliation(s)
- Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
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Lansdorp-Vogelaar I, Gulati R, Mariotto AB, Schechter CB, de Carvalho TM, Knudsen AB, van Ravesteyn NT, Heijnsdijk EAM, Pabiniak C, van Ballegooijen M, Rutter CM, Kuntz KM, Feuer EJ, Etzioni R, de Koning HJ, Zauber AG, Mandelblatt JS. Personalizing age of cancer screening cessation based on comorbid conditions: model estimates of harms and benefits. Ann Intern Med 2014; 161:104-12. [PMID: 25023249 PMCID: PMC4160041 DOI: 10.7326/m13-2867] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Harms and benefits of cancer screening depend on age and comorbid conditions, but reliable estimates are lacking. OBJECTIVE To estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation. DESIGN Collaborative modeling with 7 cancer simulation models and common data on average and comorbid condition level-specific life expectancy. SETTING U.S. population. PATIENTS U.S. cohorts aged 66 to 90 years in 2010 with average health or 1 of 4 comorbid condition levels: none, mild, moderate, or severe. INTERVENTION Mammography, prostate-specific antigen testing, or fecal immunochemical testing. MEASUREMENTS Lifetime cancer deaths prevented and life-years gained (benefits); false-positive test results and overdiagnosed cancer cases (harms). For each comorbid condition level, the age at which harms and benefits of screening were similar to that for persons with average health having screening at age 74 years. RESULTS Screening 1000 women with average life expectancy at age 74 years for breast cancer resulted in 79 to 96 (range across models) false-positive results, 0.5 to 0.8 overdiagnosed cancer cases, and 0.7 to 0.9 prevented cancer deaths. Although absolute numbers of harms and benefits differed across cancer sites, the ages at which to cease screening were consistent across models and cancer sites. For persons with no, mild, moderate, and severe comorbid conditions, screening until ages 76, 74, 72, and 66 years, respectively, resulted in harms and benefits similar to average-health persons. LIMITATION Comorbid conditions influenced only life expectancy. CONCLUSION Comorbid conditions are an important determinant of harms and benefits of screening. Estimates of screening benefits and harms by comorbid condition can inform discussions between providers and patients about personalizing screening cessation decisions. PRIMARY FUNDING SOURCE National Cancer Institute and Centers for Disease Control and Prevention.
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Obusez EC, Lian L, Kariv R, Burke CA, Shen B. Diagnostic yield of colonoscopy for constipation as the sole indication. Colorectal Dis 2012; 14:585-91. [PMID: 21689337 DOI: 10.1111/j.1463-1318.2011.02664.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM There is controversy over whether constipation as the only symptom should be an indication for routine diagnostic colonoscopy. The study was carried out to assess the prevalence of abnormal pathology on colonoscopy and to assess the risk factors for colonic neoplasia in patients with constipation but without 'high risk symptoms'. METHOD A cross-sectional, single-centre study was conducted on individuals who underwent colonoscopy for constipation as the sole indication between 2005 and 2008. Standardized endoscopic and pathology reports were reviewed. Univariable and multivariable analyses were performed. RESULTS A total of 786 patients (595 women, 75.7%; mean age, 57.4±13.5 years) underwent diagnostic colonoscopy for constipation. Forty-three (5.5%) had polyps, of whom 19 (2.4%) had hyperplastic polyps and 19 (2.4%) adenomas. No cancers were found. In patients with adenoma, the detection rate was 2.9% for patients below age 40 years and 1.7% for patients below age 50 years. Older age was associated with a polyp in both univariate and multivariate analysis. Gender, ethnicity and smoking were not associated with polyp or adenoma. CONCLUSION Colonoscopy for patients with constipation as the sole indication had a lower yield of neoplastic lesions than that for patients undergoing routine screening colonoscopy. Colonoscopy in constipation may only be warranted in patients who are over 50 years of age.
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Affiliation(s)
- E C Obusez
- Lerner College of Medicine, Department of Gastroenterology and the Cleveland Clinic, Cleveland, Ohio 44195, USA
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Loffeld RJLF, Liberov B, Dekkers PEP. Yearly diagnostic yield of colonoscopy in patients age 80 years or older, with a special interest in colorectal cancer. Geriatr Gerontol Int 2011; 12:298-303. [PMID: 22050603 DOI: 10.1111/j.1447-0594.2011.00769.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM A high diagnostic yield of colonoscopy has been reported in elderly patients, but there is no data on the yearly yield. Our aim was to detect the yearly yield of colonoscopy in elderly patients. METHODS All consecutive endoscopies in the years 1992-2009 were included. Important endoscopic diagnoses were defined as colorectal cancer (CRC), polyps, diverticuli and inflammation. RESULTS In total, 19 569 endoscopies were performed, of which 1706 (8.7%) were in patients age 80 years or older. The number of women was significantly higher (P < 0.001). The percentage of patients who were 80 years or older was higher than in the general population and remained stable during the study period, though there has been a proportional increase of elderly people in the general population. Inconclusive procedures were present in 106 (6.2%) elderly patients compared with 277 (1.6%) patients under 80 years of age (P < 0.001). There were no significant changes in the consecutive years. A procedure revealing no endoscopic diagnosis was observed less often in patients who were 80 years or older (P < 0.001). CRC was diagnosed in 221 (19.6%) older patients. This figure remained more or less constant each year. Polyps were seen in 448 (8.8%) patients 80 years of age or older. The percentage of patients with diverticuli and inflammation was constant. The number of patients 80 years or older with CRC and polyps rose at a lower rate than the number of older people in the general population. CONCLUSION The yield of colonoscopy in patients 80 years or older was high and constant over the years. The number of tumors rose less than expected compared to the increase of elderly in the general population.
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Affiliation(s)
- Ruud J L F Loffeld
- Department of Internal Medicine and Gastroenterology, Zaans Medisch Centrum, Zaandam, The Netherlands.
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Abstract
Colorectal cancer (CRC) remains the third most commonly diagnosed cancer and second leading cause of cancer death in the United States. Declines in CRC incidence and mortality over the past 20 years were attributed to CRC screening. Yet, only slightly more than half of the eligible at-risk population acknowledge being screened. To effectively meet the demands of screening in an enlarging, ethnically diverse, and aging population, a variety of modalities are needed. This article provides a focused assessment of effectiveness, limitations, and alternative available screening methods. New modalities endorsed in the updated guidelines (eg, fecal immunochemical tests, fecal DNA, and CT colonography) are reviewed. In addition, advances and updates in existing tests (eg, guaiac-based fecal occult blood tests and colonoscopy) are evaluated.
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Affiliation(s)
- Hongha T Vu
- Cleveland Clinic Foundation, Digestive Disease Institute, Department of Gastroenterology and Hepatology, Cleveland, OH 44195, USA
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Park SY, Kim HS, Yoon KW, Cho SB, Lee WS, Park CH, Joo YE, Choi SK, Rew JS. [Prevalence of colorectal adenoma is increased in patients with gastric adenoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 54:220-6. [PMID: 19844141 DOI: 10.4166/kjg.2009.54.4.220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS It has been reported that patients with gastric cancer may be at increased risk of synchronous or metachronous colorectal cancer. However, the incidence of colorectal adenoma in patients with gastric adenoma has not been discussed earlier. The aims of this study were to investigate the incidence of colorectal adenoma and to evaluate the necessity of colonoscopic surveillance in patients with gastric adenoma. METHODS We performed colonoscopy in 221 patients with gastric adenoma between January 2002 and June 2008. As a control group, 387 consecutive patients without gastric adenoma on gastroscopy who underwent colonoscopy were included. We retrospectively examined the endoscopic and colonoscopic findings as well as the clinicopathologic features. RESULTS Colorectal adenoma were diagnosed in 57.5% (127/221) of the gastric adenoma group and 38.0% (147/387) of the control group (p<0.001). Univariate analysis demonstrated that gender, age, past history of diabetes, and past history of gastric adenoma were associated with the risk of colorectal adenoma. Multivariate analysis demonstrated that gender (male, aOR 2.31, 95% CI 1.61-3.31), age (> or =50 years, aOR 2.47, 95% CI 1.53-4.01), past history of diabetes (aOR 2.35, 95% CI 1.32-4.20), and presence of gastric adenoma (aOR 1.63, 95% CI 1.13-2.36) appeared to be independent risk factors for colorectal adenoma. CONCLUSIONS The risk of colorectal adenoma increases significantly in patients with gastric adenoma. We suggest that colonoscopic surveillance may be necessary in patients with gastric adenoma.
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Affiliation(s)
- Seon Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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12
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Heitman SJ, Ronksley PE, Hilsden RJ, Manns BJ, Rostom A, Hemmelgarn BR. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009; 7:1272-8. [PMID: 19523536 DOI: 10.1016/j.cgh.2009.05.032] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/14/2009] [Accepted: 05/29/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS There is an extensive yet inconsistent body of literature reporting on the prevalence of adenomatous polyps (adenomas) and colorectal cancer among average risk individuals. The objectives of our study were to determine the pooled prevalence of adenomas and colorectal cancer, as well as nonadvanced and advanced adenomas, among average risk North Americans. METHODS Articles were obtained by searching electronic databases (MEDLINE: 1950 through March 2008 and EMBASE: 1980 through March 2008), bibliographies, major journals, and conference proceedings, with no language restrictions. Two reviewers independently selected cross-sectional studies reporting adenoma and colorectal cancer prevalence rates in average risk individuals and assessed studies for inclusion and quality, and extracted the data for analysis. Pooled adenoma and colorectal cancer prevalence rates were estimated using fixed and random effects models. Stratification and metaregression was used to assess heterogeneity. RESULTS Based on 18 included studies, the pooled prevalence of adenomas, colorectal cancer, nonadvanced adenomas, and advanced adenomas was 30.2%, 0.3%, 17.7%, and 5.7%, respectively. Heterogeneity was observed in the pooled prevalence rates for overall adenomas, advanced adenomas, and colorectal cancer and was explained by the mean age (> or = 65 years vs < 65 years) with older cohorts reporting higher prevalence rates. None of the study quality indicators was found to be significant predictors of heterogeneity. CONCLUSIONS The high prevalence of advanced adenomas and colorectal cancer, especially among older screen-eligible individuals, provides impetus for expanding colorectal cancer screening programs. Furthermore, the pooled prevalence estimates can be used as quality indicators for established programs.
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Affiliation(s)
- Steven J Heitman
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Smoot DT, Collins J, Dunlap S, Ali-Ibrahim A, Nouraie M, Lee EL, Ashktorab H. Outcome of colonoscopy in elderly African-American patients. Dig Dis Sci 2009; 54:2484-7. [PMID: 19757049 DOI: 10.1007/s10620-009-0965-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 08/20/2009] [Indexed: 01/15/2023]
Abstract
BACKGROUND Average-risk individuals should be offered a screening colonoscopy beginning at 50 years of age. However, there is no clear consensus on an age at which patients should no longer be offered a screening colonoscopy. The purpose of this study was to analyze the outcome of colonoscopy in elderly individuals based on the preprocedure indication. METHODS A retrospective chart review was performed of all patients who underwent colonoscopy at Howard University Hospital from Jan 1, 2001 to Dec 31, 2005. Patients older than age 75 years were then stratified into two groups: one group classified as average risk for colon cancer and a second group classified as higher risk for finding cancer based on indication. Significant findings from colonoscopy were assigned if the patient was found to have an advanced adenoma, such as villous attributes, high-grade dysplasia, adenoma C1 cm, or cancer. All others findings at colonoscopy were categorized as having nonsignificant findings. RESULTS During this period, 922 elderly patients (75 years of age or older) underwent colonoscopy. Based on preprocedure indications, 606 patients were considered higher risk and 316 average risk. Among the preprocedure higher-risk patients, 532 had nonsignificant findings include hemorrhoids, diverticulosis, telangiectasias, lipomas, and inflammatory polyps. Among the preprocedure average-risk patients, 286 had nonsignificant findings. From the 110 patients who underwent screening colonoscopy, 99 patients had nonsignificant findings. Malignancy was found in 42 patients: 33 who had higher-risk indications and 9 who had average-risk indications. CONCLUSION Average-risk patients are less likely to have significant findings, including cancer, on colonoscopy.
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Affiliation(s)
- Duane T Smoot
- Gastroenterology Division, Department of Medicine, Cancer Center, Howard University College of Medicine, NW, Washington, DC 20060, USA
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Screening colonoscopy for colorectal cancer prevention: results from a German online registry on 269000 cases. Eur J Gastroenterol Hepatol 2009; 21:650-5. [PMID: 19445041 DOI: 10.1097/meg.0b013e32830b8acf] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The efficacy of screening colonoscopy in general use remains to be determined. Here we report data over a 39-month study period collected in a nationwide online registry. STUDY Data from consecutive screening colonoscopies performed on asymptomatic patients in the practices of 280 participating gastroenterologists (age 55-99 years) were collected in an online registry. The number and histology of colorectal polyps and carcinomas, complication rates of colonoscopy and polypectomy were registered. Advanced adenoma was defined as an adenoma of >or= 10 mm in diameter, villous or tubulovillous in histology, or presence of high-grade dysplasia. RESULTS A total of 269 144 colonoscopies (male 44%) were evaluated. Tubular, villous/tubulovillous adenomas and invasive cancers were found in 15.6, 3.7, and 0.8%, respectively. Advanced adenomas amounted to 7.1%. In 95% of polyps greater than 5mm and less than 30 mm immediate polypectomy was performed. In 399 of the 575 carcinomas with complete tumor node metastasis stages, which were detected during colonoscopy, early stages dominated (UICC stages I and II in 43 and 27%, respectively). Complication rate was low and no fatalities were observed: cardiopulmonary complication in 0.10% of the colonoscopies, bleeding in 0.8% of polypectomies most of which were managed endoscopically (surgery in 0.03% of polypectomies). Perforation occurred in 0.02% of the colonoscopies and 0.09% of polypectomies. CONCLUSION Colonic neoplasias are detected in about 20% of patients most of which are immediately removed by polypectomy at a low risk. Polypectomy of adenomas and low UICC stages in cancer patients during screening colonoscopy may be tools for fighting colorectal cancer mortality.
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Park HW, Byeon JS, Yang SK, Kim HS, Kim WH, Kim TI, Park DI, Kim YH, Kim HJ, Lee MS, Chung IK, Jung SA, Jeen YT, Choi JH, Choi H, Choi KY, Han DS, Song JS. Colorectal Neoplasm in Asymptomatic Average-risk Koreans: The KASID Prospective Multicenter Colonoscopy Survey. Gut Liver 2009; 3:35-40. [PMID: 20479899 DOI: 10.5009/gnl.2009.3.1.35] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 09/11/2008] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS The incidence of colorectal cancer is increasing in Korea, but the epidemiology of colorectal neoplasm is not clearly defined. We aimed to elucidate the prevalence of colorectal neoplasm in average-risk Koreans and explore the underlying risk factors. METHODS A large-scale, multicenter, prospective study was conducted. Of the 19,460 subjects who underwent colonoscopy at 11 university hospitals, we analyzed 3,951 consecutive asymptomatic adults with no risk factors for colorectal cancer. RESULTS The subjects were aged 52.1+/-11.6 years (mean+/-SD) and 60.1% of them were men. The prevalences of colorectal neoplasm and advanced neoplasm were 33.3% and 2.2%, respectively. The prevalence of a neoplasm increased with age (trend: p<0.001) and was higher in males (p<0.001). The prevalence of a proximal neoplasm was higher in subjects with a distal neoplasm than in those without a distal neoplasm (11.9% vs. 5.4%, p<0.001). However, 150 (52.1%) of the 288 subjects with a proximal neoplasm had no distal neoplasm. CONCLUSIONS The overall prevalence of colorectal neoplasm in asymptomatic average-risk Koreans is comparable with that in Western countries. Being male and older are associated with a higher risk of colorectal neoplasm. Over half of proximal neoplasms are not associated with any distal sentinel lesions.
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Affiliation(s)
- Hye-Won Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sheinfeld Gorin S, Gauthier J, Hay J, Miles A, Wardle J. Cancer screening and aging: Research barriers and opportunities. Cancer 2008; 113:3493-504. [DOI: 10.1002/cncr.23938] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Joosten E, Meeuwissen J, Vandewinckele H, Hiele M. Iron status and colorectal cancer in symptomatic elderly patients. Am J Med 2008; 121:1072-7. [PMID: 19028203 DOI: 10.1016/j.amjmed.2008.06.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 05/22/2008] [Accepted: 06/23/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study aim is to determine the relationship between the prevalence of colorectal cancer and iron status in elderly anemic and non-anemic patients. METHODS We retrospectively investigated 359 consecutive elderly patients, aged 70 years and more, who presented to a geriatric department and who underwent a total colonoscopy. The histopathologic diagnosis of colorectal carcinoma was the primary outcome measure, and its presence was compared with the iron status, evaluated by serum ferritin and hemoglobin levels. RESULTS Less than half of the patients with colorectal carcinoma had iron-deficiency anemia. The prevalence of colorectal carcinoma was similar among patients with a serum ferritin level less than 50 microg/L (16%), between 50 and 100 mirog/L (20%), and greater than 100 microg/L (13%), and was not different between anemic and non-anemic patients. Sex (odds ratio for men 2.1; 95% confidence interval [CI], 1.2-3.9) and increasing age (6.6% per year; 95% CI, 1.2-12.4), but not hemoglobin and serum ferritin, were independent risk factors for colorectal carcinoma. Those with a proximal colorectal carcinoma had a lower hemoglobin and ferritin level and a higher prevalence of iron-deficiency anemia compared with patients with a distal colorectal carcinoma. CONCLUSION The prevalence of colorectal carcinoma is high in anemic and non-anemic elderly symptomatic patients, irrespective of the iron status. Therefore, the decision to order a colonoscopy in older patients should not only be considered in patients with anemia or iron deficiency but also in patients with suspicious symptoms without anemia or iron deficiency.
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Affiliation(s)
- Etienne Joosten
- Department of Internal Medicine, Division of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
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Mansmann U, Crispin A, Henschel V, Adrion C, Augustin V, Birkner B, Munte A. Epidemiology and quality control of 245 000 outpatient colonoscopies. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:434-40. [PMID: 19626186 PMCID: PMC2696904 DOI: 10.3238/arztebl.2008.0434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 05/09/2008] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Screening colonoscopy is an effective means for early detection of colorectal carcinoma. Any exhaustive evaluation of the method must take further factors into account: epidemiology of colorectal adenomas and carcinomas in the target population, acceptance by the patients, structure, process, and outcome quality, and health economics. METHODS The internet-based colonoscopy database of the Bavarian Association of Statutory Health Insurance Physicians (ASHIP) for the year 2006 includes data on 86.05% of all outpatient colonoscopies performed in Bavarian ASHIP patients, or a total of 245 263 documented examinations. RESULTS The rate of participation in preventive colonoscopies was low (1.5%) and showed considerable geographical variation. The rate of detection of histologically confirmed colorectal neoplasia in symptom-free screened individuals was almost 26.0%. Some 1.3% of those screened had colorectal carcinoma. In 76.31% of the participants a completely clean gut was achieved. The incidence of bleeding, perforation, and cardiorespiratory complications was 0.22%, 0.03%, and 0.06%, respectively. DISCUSSION The complication rate of outpatient colonoscopy is on the order of tenths of a percent, while the process quality is high. The rate of detection of colorectal adenoma and carcinoma is high and the projected benefits for public health are considerable, but the rate of participation is too low.
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Affiliation(s)
- Ulrich Mansmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, Munich, Germany.
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Ladas SD. Ethical issues in the management of elderly patients in gastroenterology and digestive endoscopy. Expert Rev Gastroenterol Hepatol 2007; 1:257-63. [PMID: 19072418 DOI: 10.1586/17474124.1.2.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Over the past 30 years, the population of old-aged citizens in most Western countries has been dramatically increasing. These people usually have several comorbidities and often lose their independence, mostly due to neurodegenerating diseases. Benign and malignant gastrointestinal disorders are very common in all age groups, but their incidence increases with age, requiring investigation and therapy. In this setting several ethical issues arise, mostly related to the extent of invasive investigations, adverse drug reactions due to polypharmacy, the risk:benefit ratio of endoscopic therapy, and the quality and validity of informed consent in this frail elderly population.
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Affiliation(s)
- Spiros D Ladas
- 1st Department of Internal Medicine-Propaedeutic, University of Athens, Laiko General Hospital of Athens, Medical School, Athens, Greece.
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Kahi CJ, Azzouz F, Juliar BE, Imperiale TF. Survival of elderly persons undergoing colonoscopy: implications for colorectal cancer screening and surveillance. Gastrointest Endosc 2007; 66:544-50. [PMID: 17725944 DOI: 10.1016/j.gie.2007.01.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 01/04/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the elderly, the increased prevalence of colorectal neoplasia and the protective effect of colonoscopy may be offset by advancing age and comorbidity. OBJECTIVE To describe and quantify the endoscopic findings, survival, and predictors of mortality of elderly persons after colonoscopy. DESIGN, SETTING, AND PATIENTS Retrospective cohort study of persons aged>or=75 years who underwent colonoscopy in 1999 and 2000 at a U.S. Veterans Affairs facility and urban county hospital. MAIN OUTCOME MEASURES Advanced neoplasms were defined as colorectal cancer (CRC), polyp with high-grade dysplasia, villous histologic features, or tubular adenoma>or=1 cm. Comorbidity was measured with the Charlson comorbidity index. Subjects were followed until death or study closure. RESULTS Of 469 eligible subjects, 65 were excluded and 404 were included in the study. Fifty-nine of 404 (15%) had an advanced neoplasm, including 8 (2%) with CRC. There were 167 deaths (41%); the mean overall survival was 4.1+/-0.1 years (median 5.95 years). A symptomatic indication for colonoscopy was not predictive of death. Mortality was predicted by age (hazard ratio 1.16 for each year increase beyond age 75 years, 95% CI 1.07-1.3, P=.0003) and Charlson score (hazard ratio 8.3 for each point increase, 95% CI 1.4-48.5, P=.02). The median survival of patients aged 75 to 79 years was >5 years if the Charlson score was <or=4. Among patients aged>or=80 years, the median survival was <5 years regardless of Charlson score. LIMITATIONS Retrospective design. CONCLUSIONS In this cohort of elders, age and comorbidity were predictors of death. The protective effect of younger age lessens as comorbidity increases. These findings may have important implications for CRC screening and surveillance in elders.
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Affiliation(s)
- Charles J Kahi
- Indiana University Medical Center, Roudebush Veterans Affairs Medical Center, Indiana University Department of Biostatistics, Indianapolis, Indiana 46202, USA
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Choe JW, Chang HS, Yang SK, Myung SJ, Byeon JS, Lee D, Song HK, Lee HJ, Chung EJ, Kim SY, Jung HY, Lee GH, Hong WS, Kim JH, Min YI. Screening colonoscopy in asymptomatic average-risk Koreans: analysis in relation to age and sex. J Gastroenterol Hepatol 2007; 22:1003-8. [PMID: 17608845 DOI: 10.1111/j.1440-1746.2006.04774.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Although the incidence of colorectal cancer is rising in Asian countries, there are no guidelines for its screening in this region due in part to the lack of epidemiological data regarding colorectal neoplasms. This study aimed to evaluate the prevalence of colorectal neoplasms in average-risk Koreans and to assess the effectiveness of screening colonoscopy in Korea. METHODS The prevalence of colorectal neoplasms was assessed by primary screening colonoscopy in 5,086 consecutive asymptomatic adults (males 70.5%; age 20-84 years) with no risk factors for colorectal cancer. RESULTS The overall prevalence of colorectal neoplasms in the 5,086 subjects was 21.9% and this increased linearly with age. Among the 2,435 subjects aged >or=50 years (males 66.7%; mean age 57.7 years), the prevalence of all colorectal neoplasms was 30.2% (males 35.9% vs females 18.7%; P < 0.001), while advanced neoplasms accounted for only 4.1% (males 5.1% vs females 2.0%; P < 0.001). The prevalence of advanced neoplasms in Korean men of a specific age group was similar to that of Korean women in the 10-years older age group. Also, Koreans in a specific age group showed a prevalence of advanced neoplasms similar to that of Westerners in the 10-years younger age group. CONCLUSIONS Colonoscopy is a useful modality for colorectal cancer screening in Korea, as established in Western countries. However, the screening colonoscopy may begin at an older age for Koreans than for Westerners. Similarly, the optimal starting age for screening in Korean women may be higher than that in men by 10 years.
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Affiliation(s)
- Jae Won Choe
- Department of Internal Medicine, Health Promotion Center, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
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Pasetto LM, Monfardini S. Colorectal cancer screening in elderly patients: when should be more useful? Cancer Treat Rev 2007; 33:528-32. [PMID: 17553621 DOI: 10.1016/j.ctrv.2007.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 04/10/2007] [Accepted: 04/15/2007] [Indexed: 11/18/2022]
Abstract
Current guidelines endorse colon cancer screening every 5-10 years in persons over 50 years of age. However, there is no consensus regarding what age is appropriate to stop screening. Prior history of neoplasia seems to be a strong risk factor for colorectal neoplasia development in elderly people and should be considered when deciding the need for continuing screening/surveillance, however, clinical judgment of comorbidities is still required to individualize screening practice. Screening colonoscopy in very elderly persons (aged 80 years), i.e. should be performed only after careful consideration of potential benefits, risks and patient preferences. The aims of this paper are to: (1) determine the best type of colorectal cancer screening (faecal occult blood testing, flexible sigmoidoscopy, double-contrast barium enema and colonoscopy) and its association with age and health status among elderly veterans and (2) describe the outcomes of colorectal cancer screening among older veterans who have widely differing life expectancies (based on age and health status).
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Affiliation(s)
- Lara Maria Pasetto
- Istituto Oncologico Veneto, IRCCS: Medical Oncology 2nd, Via Gattamelata 64, 35128 Padova, Italy.
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Zerey M, Paton BL, Khan PD, Lincourt AE, Kercher KW, Greene FL, Heniford BT. Colonoscopy in the very elderly: a review of 157 cases. Surg Endosc 2007; 21:1806-9. [PMID: 17353977 DOI: 10.1007/s00464-007-9269-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 12/14/2006] [Accepted: 01/08/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Colonoscopy is currently the best diagnostic modality for evaluating colonic diseases but studies of its use in the very elderly are limited. METHODS A single-institution review of all patients aged 85 years or older who underwent colonoscopy from June 2003 to June 2005 was performed. Parameters evaluated included indications for colonoscopy, findings, ability to perform a complete colonoscopy, and immediate and delayed (< or =21 days) complications. RESULTS A total of 157 patients aged 85 years or older (median = 87, range = 85-99) underwent colonoscopy during the two-year period. The cecal intubation rate was 90%. Number of cancers detected/indications for colonoscopy include gross or occult bleeding per rectum, 3/51 (5.9%); abnormal physical exam, 1/2 (50%); abnormal abdominal computed tomography, 3/5 (60%); anemia, 1/25 (4.0%); screening, 0/14; previous history of colonic malignancy, 0/10; previous history of polyps, 0/21; change in bowel habits, 0/5; family history of colonic malignancy, 0/6; abdominal pain, 0/4; diarrhea, 0/6; fecal impaction, 0/2; unknown, 0/6. Immediate complications included hemorrhage at a polypectomy site in one patient that was controlled endoscopically, one episode of bradycardia, and one incident of atrial fibrillation. There were no delayed complications resulting from colonoscopy. CONCLUSIONS Our data suggest that colonoscopy can be safely and successfully performed in the very elderly. In patients with symptoms or suggestive radiographic findings, cancer was detected in 4.0%-60% of cases. No cases of cancer were discovered in those patients who were asymptomatic.
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Affiliation(s)
- Marc Zerey
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA
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Harewood GC, Lawlor GO, Larson MV. Incident rates of colonic neoplasia in older patients: when should we stop screening? J Gastroenterol Hepatol 2006; 21:1021-5. [PMID: 16724989 DOI: 10.1111/j.1440-1746.2006.04218.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Current guidelines endorse colon cancer screening every 5-10 years in patients over 50 years of age. However, there is no consensus regarding what age is appropriate to stop screening. The aim of this study was to characterize neoplasia occurrence/recurrence in a large cohort of patients > or =70 years of age undergoing colonoscopy. METHODS The Mayo Rochester endoscopic database was reviewed to determine the incidence of colonic neoplasia in patients > or =70 years undergoing two colonoscopies at least 12 months apart between January 1996 and December 2000. Patients were classified based on (i) age: 70-74, 75-79, > or =80 years; and (ii) polyp detection on initial examination, that is, subsequent examination for screening or surveillance. RESULTS Overall, 1353 patients underwent two colonoscopies at least 12 months apart (median interval 140 weeks) with removal of polyp on initial examination in 726 (53.7%) patients (surveillance cohort). On subsequent endoscopy, polyps > or =10 mm were detected in 54 (4.0%) and cancer in 13 (1.0%) patients. All age groups were well matched with respect to detection of neoplasia on index examination (P = 0.9) and polyp size on initial colonoscopy among the surveillance group (P = 0.9). Using a Cox proportional hazards model, adjusted hazard ratios (95% confidence interval [CI]) for neoplasia (polyps > or =10 mm) were: 2.0 (1.50-2.73, P < 0.0001) (surveillance vs screening), 1.33 (0.96-1.79, P = 0.08) (> or =80 vs 70-74), and 1.05 (0.78-1.38, P = 0.75) (75-79 vs 70-74). Adjusted hazard ratios for development of cancer were: 1.87 (1.03-3.97, P = 0.04) (surveillance vs screening), 1.73 (0.84-3.56, P = 0.13) (> or =80 vs 70-74), and 1.38 (0.71-2.77, P = 0.34) (75-79 vs 70-74). CONCLUSIONS Prior history of neoplasia remains a strong risk factor for colorectal neoplasia development in elderly patients and should be considered when deciding the need for continuing screening/surveillance. Incident neoplasia rates in a previously screened elderly population rise slowly with advancing age although cancer rates rise more sharply. Therefore, screening still retains a role in elderly patients; however, clinical judgment is still required to individualize screening practice. As the risk of competing comorbid illnesses continues to increase over time, the threshold to perform colon screening should increase accordingly.
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Affiliation(s)
- Gavin C Harewood
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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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. [PMID: 16482421 DOI: 10.1007/s10350-005-0306-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- James E Duncan
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 393 Dunlap Street North, Suite 500, St. Paul, Minnesota 55104, USA
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Qureshi WA, Zuckerman MJ, Adler DG, Davila RE, Egan JV, Gan SI, Lichtenstein DR, Rajan E, Shen B, Fanelli RD, Van Guilder T, Baron TH. ASGE guideline: modifications in endoscopic practice for the elderly. Gastrointest Endosc 2006; 63:566-9. [PMID: 16564853 DOI: 10.1016/j.gie.2006.02.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Waqar A Qureshi
- American Society for Gastrointestinal Endoscopy, 1520 Kensington Road, Ste. 202, Oak Brook, IL 60523, USA
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Abstract
OBJECTIVES To evaluate the use of colonoscopy in patients aged at least 85 years. Does the ideal of an ageism free service apply? DESIGN A retrospective audit. SETTING Department of gastroenterology that carries out about 1000 colonoscopies annually in a district general hospital serving a population of about 320 000. SUBJECTS All patients aged at least 85 years who underwent colonoscopy over five years to 2003. MAIN OUTCOME MEASURES The indications for colonoscopy and its findings. The outcome of patients found to have colonic cancers. RESULTS Colonoscopy was completed in 219 cases (69%). The main reasons for failure were poor bowel preparation and severe diverticular disease. Normal findings occurred in 65 (30%) of the 219 cases that had had a complete examination. Colonoscopy identified a problem that explained the patient's symptoms in 116 (37%) cases. Polyps were found in 45 (14.2%) cases and malignancy in 28 (8.8%). CONCLUSIONS The absence of significant complications and comparatively high yield of colonic malignancies and polyps reinforces the value of colonoscopy as a diagnostic tool even after 85 years of age and despite the technical challenges of the procedure in this age group that limited completion. Increasing age alone should not preclude a patient from colonoscopy.
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Affiliation(s)
- K K Y Yoong
- Department of Gastroenterology, Kingston Hospital NHS Trust, Galsworthy Road, Kingston upon Thames KT2 7QB, UK.
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Kirchgatterer A, Steiner P, Hubner D, Fritz E, Aschl G, Preisinger J, Hinterreiter M, Stadler B, Knoflach P. Colorectal cancer in geriatric patients: Endoscopic diagnosis and surgical treatment. World J Gastroenterol 2005; 11:315-8. [PMID: 15637734 PMCID: PMC4205327 DOI: 10.3748/wjg.v11.i3.315] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence of colorectal cancer in geriatric patients undergoing endoscopy and to analyze their outcome.
METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. Patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival.
RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). Patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively.
CONCLUSION: Nearly two-thirds of 88 geriatric patients with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatric patients is demonstrated.
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Affiliation(s)
- Andreas Kirchgatterer
- First Department of Medicine/Gastroenterology, General Hospital Wels, A-4600 Wels/Austria, Grieskirchnerstrasse 42, Austria.
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Bretagne JF. [Surveillance colonoscopy following polypectomy or curative resection of colorectal cancer]. ACTA ACUST UNITED AC 2004; 28:D178-89. [PMID: 15213678 DOI: 10.1016/s0399-8320(04)95002-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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