Colonoscopy in the octogenarian population: Diagnostic and survival outcomes from a large series of patients

• Published in: The surgeon (Edinburgh) 2011-08, Vol.9 (4), p.195-199
• Main Authors: Khan, Shakeeb, Ahmed, Jamil, Lim, Michael, Owais, Anwar, McNaught, Clare, Mainprize, Karl, Babu, Sathish, Renwick, Ian, MacFie, John, Mitchell, Charles
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Colonic Diseases - diagnosis; Colonic Diseases - epidemiology; Colonoscopy; Colonoscopy - utilization; Colorectal cancer; CT colonoscopy; Diagnosis, Differential; Humans; Male; Middle Aged; Octogenarians; Prevalence; Risk Factors; Surgery; Survival Rate - trends; United Kingdom - epidemiology
• ISSN: 1479-666X; 2405-5840
• DOI: 10.1016/j.surge.2010.09.003

Abstract Objective Our aim was to audit the diagnostic and survival outcomes of colonoscopy in octogenarians and to determine if it confers any survival benefit. Methods A review of a prospectively maintained database over a two year period between October 2005 and September 2007 was undertaken. Data on numerous outcome variables and survival were collected and analysed. Categorical variables were compared using the Chi-square test. Kaplan–Meier survival curves were constructed and log rank test were used to compare survival curves. Results There were 1905 patients, of which 289 (15%) were over the age of 80 years. Caecal intubation was significantly lower in octogenarians when compared with young patients (239/289, (82%) vs. 1411/1616 (88%), p  = 0.025). The most common reason for failure to intubate the caecum was presence of stenosing pathology in distal bowel (octogenarians 46% (23 out of 50 failed intubations) vs. young 23% (49 out of 205 failed intubations), p  = 0.002). A greater proportion of octogenarians had poor bowel preparation when compared with the young (20% vs. 13%, p  = 0.001). Significantly more pathology was detected in octogenarians (72% vs. 59%, p  = 0.001). Forty-four (15.2%) octogenarians were found to have malignancy. Of these, only 23 (52%) underwent subsequent surgery. Median survival of octogenarians who had surgery was not statistically better (31 (IQR 12–38) months vs. 16 (IQR 5-31) months, p  = 0.10) than those who did not. Conclusion Colonoscopy is safe in octogenarians and provides a high yield. Our results suggest that it does not appear to result in any survival benefit. However, to establish this, further research with larger cohorts and longer follow-up periods would be required.