Current practice in colonoscopy in the elderly

Colonoscopy in the elderly is a reliable practice of great diagnostic and management value. However, patient’s age has long been considered to af- fect the success of the procedure, achieved when the ce- cum is intubated, there is a good view of the colon if preparation has been properly carried out, and the ex- amination does not cause excessive discomfort or complications. Substantial improvements have been made to the latter two aspects, due to more widespread use of deep sedation with propofol and cardiocircula- tory monitoring during the procedure. The aim of our work was to assess whether, in the everyday prac- tice of an open-access, digestive endoscopy teaching center, staffed by various providers delivering screen- ing for polyposis, age is still a limitation to the success of the procedure and whether appropriate measures have been taken to improve colonoscopy in geriatric pa- tients. We analysed 1480 consecutive colonoscopies, of which 319 were performed in patients aged over 73 years. The examination was significantly less success- ful in this group of patients (88.1 vs 94.4, p=0.0001), but there were no major technical or use-related com- plications connected with administration of propofol for sedation purposes, despite lower doses to the el- derly (2.2±1.1 mg/kg total dose, mean 151±72.4 mg vs 2.9±1.3 mg/kg total dose, mean 199±77.9 mg in younger patients, p<0.001). More experienced tech- nical staff were not allocated to these colonoscopies (for endoscopic or anesthesiological purposes) and, according to the results of multivariate stepwise logistic regression analysis, inadequate preparation was the main factor affecting the success of the procedure in el- derly patients (OR 5.9, 95% CI 2.25-15.72; p=0.0003). Only body weight over 60 kg facilitated it (weight ≥60 kg, OR 0.46, 95% CI 0.26-0.83). In colonoscopy in the elderly, safety appears to be the primary concern and, good outcomes can be achieved, but sometimes at the expense of diagnostic accuracy. This could probably be improved through better pre- and post-procedure care, not currently differentiated between young and elderly patients.