Yield of Surveillance Colonoscopy in Older Adults with a History of Polyps: A Systematic Review and Meta-Analysis

• Published in: Digestive diseases and sciences 2022-08, Vol.67 (8), p.4059-4069
• Main Authors: Williams, Gregory J., Hellerstedt, Sage T., Scudder, Paige N., Calderwood, Audrey H.
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Biochemistry; Colonic Polyps - diagnosis; Colonic Polyps - epidemiology; Colonoscopy; Colonoscopy - methods; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Gastroenterology; Hepatology; Humans; Medicine; Medicine & Public Health; Meta-analysis; Odds Ratio; Older people; Oncology; Original Article; Polyps; Polyps (Pathology); Surveillance; Systematic review; Transplant Surgery
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-021-07198-6

Background The benefit of surveillance colonoscopy in older adults is not well described. Aims To quantify the detection of colorectal cancer (CRC) and advanced polyps during surveillance colonoscopy in older adults with a history of colon polyps. Methods We conducted a systematic review (MEDLINE, Cochrane Library, Web of Science, and Embase) for all published studies through May 2020 in adults age > 70 undergoing surveillance colonoscopy. The main outcome was CRC and advanced polyps detection. We performed meta-analysis to pool results by age (>70 vs. 50–70). Results The search identified 6239 studies, of which 569 underwent full-text review and 64 data abstraction, of which 19 were included. The risk of detecting CRC ( N  = 11) was higher in those >70 compared to 50–70 (risk ratio 1.5 (95% CI 1.1–2.2); risk difference 0.8% (95% CI −0.2%–1.8%)). Similarly, the risk of detecting advanced polyps ( N  = 8) was higher in those >70 compared to 50–70 (risk ratio 1.3 (95% CI 1.2–1.3), risk difference 2.7% (95% CI 1.3%–4.0%)). Most studies did not stratify results by baseline polyp risk. Conclusions The detection of CRC and advanced polyps during surveillance colonoscopy in older individuals was higher than in younger controls; however, the absolute risk increase for both was small. These differences must be weighed against competing medical problems and limited life expectancy in older adults when making decisions about surveillance colonoscopy. More primary data on the risks of CRC and advanced polyps accounting for number of past colonoscopies, prior polyp risk, and duration of time since last polyp are needed.