One-stop colonoscopy-based management of colorectal polyps and internal hemorrhoids in older adults: A real-world cohort study

Table 1 Baseline characteristics by age group, n (%)/median (interquartile range)

Variable	≥ 65 years (n = 100)	< 65 years (n = 561)	P value	SMD
Age, years	69.0 (67.0-72.0)	48.0 (39.0-56.0)	< 0.001	-
Male sex	51 (51.0)	310 (55.3)	0.431	-0.085
BMI	23.9 (21.1-25.5)	23.9 (21.6-26.1)	0.375	-0.175
Hemorrhoid grade			0.482	-
Grade I	5 (5.0)	24 (4.3)
Grade II	74 (74.0)	445 (79.3)
Grade III	21 (21.0)	92 (16.4)
Presenting symptoms			0.109	-
Bleeding	54 (54.0)	268 (47.8)
Prolapse	11 (11.0)	34 (6.1)
Bleeding and prolapse	4 (4.0)	36 (6.4)
Other symptoms	31 (31.0)	223 (39.8)
Comorbidity status			< 0.001
Hypertension	21 (21.0)	81 (14.4)		0.172
Diabetes mellitus	10 (10.0)	19 (3.4)		0.267
Cardiovascular disease	4 (4.0)	5 (0.9)		0.202
Malignancy history	0 (0.0)	2 (0.4)		-0.085
Multiple comorbidities	23 (23.0)	28 (5.0)		0.537
Follow-up time, months	12.0 (10.0-12.0)	12.0 (9.0-12.0)	0.977	0.037

P values were calculated using the Mann-Whitney U test for continuous variables and the Pearson χ² test, Fisher’s exact test, or the Fisher-Freeman-Halton exact test for categorical variables, as appropriate. Standardized mean differences were calculated for binary variables and selected continuous variables to describe the magnitude of between-group differences. Comorbidity categories were mutually exclusive. Patients with a single comorbid condition were classified according to that condition, whereas patients with two or more comorbid conditions were classified as having multiple comorbidities. Standardized mean differences were not calculated for multicategorical variables (hemorrhoid grade and presenting symptoms). SMD: Standardized mean difference; BMI: Body mass index.

Table 2 Treatment and procedural characteristics by age group, n (%)/median (interquartile range)

Variable	≥ 65 years (n = 100)	< 65 years (n = 561)	P value
Concomitant polypectomy	88 (88.0)	412 (73.4)	0.002
Polyp location1			0.055
Ascending colon	4 (4.5)	22 (5.3)
Transverse colon	2 (2.3)	18 (4.4)
Descending colon	1 (1.2)	13 (3.2)
Sigmoid colon	13 (14.8)	93 (22.6)
Rectum	2 (2.3)	32 (7.8)
Multiple locations	66 (75.0)	234 (56.8)
Maximum polyp diameter1, mm	6 (5.0-10.0)	6 (5.0-7.0)	< 0.001
Hemorrhoid treatment modality			0.106
RBL	43 (43.0)	194 (34.6)
EPFS	57 (57.0)	367 (65.4)
Intravenous anesthesia	88 (88.0)	531 (94.7)	0.012
Hemorrhoid procedure time, minutes	10.4 (8.5-13.6)	10.2 (8.1-13.1)	0.618
Total operation duration, minutes	32.1 (22.9-40.1)	25.2 (20.3-32.0)	< 0.001

¹Analyses were limited to patients who underwent concomitant polypectomy (≥ 65 years, n = 88; < 65 years, n = 412).

P values were calculated using the Pearson χ² test, Fisher’s exact test, the Fisher-Freeman-Halton exact test, or the Mann-Whitney U test, as appropriate. RBL: Rubber band ligation; EPFS: Endoscopic polidocanol foam sclerotherapy.

Table 3 Clinical outcomes of endoscopic treatment by age group, n (%)

Variable	≥ 65 years (n = 100)	< 65 years (n = 561)	P value	RD, %	95%CI
Symptom improvement	82 (82.0)	462 (82.4)	0.932	-0.4	-9.5 to 6.8
Postprocedural discomfort			0.263	-	-
Pain	6 (6.0)	16 (2.9)		-	-
Anal distention	2 (2.0)	24 (4.3)		-	-
Bleeding	2 (2.0)	10 (1.8)		-	-
Cost acceptance	85 (85.0)	470 (83.8)	0.759	1.2	-7.5 to 7.8
Patient satisfaction			0.335	-	-
Satisfied	94 (94.0)	511 (91.1)		2.9	-3.9 to 7.1
Unsatisfied	6 (6.0)	50 (8.9)		-	-
> 1 treatment session	2 (2.0)	21 (3.7)	0.557	-1.7	-4.1 to 3.4

P values were calculated using the Pearson χ² test, Fisher’s exact test, or the Fisher-Freeman-Halton exact test, as appropriate. All tests were two-sided. Risk differences and corresponding 95% confidence intervals for the primary outcome and selected clinically relevant secondary outcomes were calculated from raw 2 × 2 contingency tables using the Newcombe score method, without multivariable adjustment. Risk differences were calculated as the proportion in the ≥ 65-year group minus that in the < 65-year group. RD: Risk difference; CI: Confidence interval.

Table 4 Clinical outcomes within elderly patients by age subgroups, n (%)

Variable	≥ 70 years (n = 45)	65-69 years (n = 55)	P value
Symptom improvement	38 (84.4)	44 (80.0)	0.565
Postprocedural discomfort			0.593
Pain	3 (6.7)	3 (5.5)
Anal distention	2 (4.4)	0 (0.0)
Bleeding	1 (2.2)	1 (1.8)
Cost acceptance	35 (77.8)	50 (90.9)	0.067
Patient satisfaction			1.000
Satisfied	42 (93.3)	52 (94.5)
Unsatisfied	3 (6.7)	3 (5.5)
> 1 treatment session	1 (2.2)	1 (1.8)	1.000

P values were calculated using the Pearson χ² test, Fisher’s exact test, or the Fisher-Freeman-Halton exact test, as appropriate. All tests were two-sided.