The Yield and Safety of Screening and Surveillance Colonoscopy in Elderly Patients (> 80 Years)

Background and Clinical Significance:

Colorectal cancer continues to carry a significant burden of morbidity and mortality into the twenty-first century, despite the availability of multiple screening modalities. It is estimated that approximately 150,000 new cases of CRC will be diagnosed and over 50,000 people will die of CRC in 2006 (1). Current options for screening for CRC include fecal occult-blood testing, flexible sigmoidoscopy, double contrast barium enema, and colonoscopy. While no randomized controlled trials have shown a mortality benefit with screening colonoscopy, it has become the preferred method of both screening and surveillance of polyps because of the ability to visualize the entire colon in addition to having the ability to remove polyps. This procedure does associated risks including perforation and bleeding after polypectomy. Other major complications have also been reported, including MI and CVA.

Although guidelines exist for colorectal cancer screening and surveillance of polyps, they do not define the upper age limit to which these practices should be carried out (2,3). No clear data is available on the effect of this procedure on life expectancy after the age of 80. Also, the country has limited resources and screening colonoscopy may be offered to those who are most likely to benefit. Based on these facts, there is a real need to quantify the prevalence of colon neoplasia in this age group to guide primary care physicians as well as gastroenterologists in offering screening and surveillance colonoscopy to this age group. Like many medical decisions, cancer screening requires weighing quantitative information, such as risk of cancer death and likelihood of beneficial and adverse screening outcomes, as well as qualitative factors, such as individual patients' values and preferences. In fact, patients with life expectancies of less than 5 years are unlikely to derive any survival benefit from cancer screening. There is also potential for harm from screening procedures. Some of the greatest harms of screening occur by detecting cancers that would never have become clinically significant. This becomes more likely as life expectancy decreases.

As the population ages and life expectancy continues to increase, more elderly patients will be referred for colonoscopy. What is the utility of performing colonoscopy in these asymptomatic patients, and is it safe? Few studies have examined this question adequately. What follows is a brief review of published data in regards to yield and safety of colonoscopy in the elderly.

Yield: