Key points How common is screening colonoscopy and what results are obtained when performed in asymptomatic patients over 75 years of age with a life expectancy of less than 10 years? Findings In this cross-sectional study with a nested cohort that included 7067 patients older than 75 years who underwent screening colonoscopies, the percentage of colonoscopies performed in patients with a life expectancy of less than 10 years was 30% for those aged 76 to 80 years, 71% for those from 81 years to 85 years, and 100% of patients over 85 years. Fifteen patients (0.2%) were found to have invasive adenocarcinoma with 5 patients undergoing anticancer treatment; Furthermore, adverse events requiring hospitalization were common at 10 days (13.58 per 1000) and increased with age, particularly among patients older than 85 years. Meaning In patients older than 75 years, a large proportion of screening colonoscopies, which were also associated with an increased risk of complications , were performed among patients with a limited life expectancy (<10 years); Colorectal cancer was rarely detected and rarely acted upon. |
Importance
The benefits of colorectal cancer (CRC) screening can take 10 to 15 years to accrue. Therefore, screening is recommended for older adults who are in good health.
Aim
To determine the number of screening colonoscopies performed in patients over 75 years of age with a life expectancy of less than 10 years, diagnostic yield and associated adverse events within 10 days and 30 days of the procedure.
Design
This cross-sectional study with a cohort nested between January 2009 and January 2022 in an integrated health system evaluated asymptomatic patients older than 75 years who underwent screening colonoscopy in the outpatient setting. Reports with incomplete data, any indication other than screening, patients who had undergone a colonoscopy in the previous 5 years, and patients with a personal history of inflammatory bowel disease or colorectal cancer (CRC) screening were excluded.
Exhibitions
Life expectancy based on a prediction model from previous literature.
Main results and measures
The primary outcome was the percentage of patients screened who had a limited life expectancy (<10 years). Other outcomes included colonoscopy findings and adverse events that developed within 10 and 30 days after the procedure.
Results
A total of 7067 patients over 75 years of age were included . The median (IQR) age was 78 (77-79) years, 3967 (56%) were female, and 5431 (77%) were white with a median of 2 comorbidities (taken from a select group of comorbidities). The proportion of colonoscopies performed on patients with a life expectancy of less than 10 years from 76 to 80 years was 30% in both sexes and increased with age, 82% of men and 61% of women from 81 to 85 years (71 % total), and 100% of patients over 85 years of age.
Adverse events requiring hospitalizations were common at 10 days (13.58 per 1000) and increased with age, particularly among patients older than 85 years. Detection of advanced neoplasia ranged from 5.4% among patients aged 76 to 80 years, to 6.2% in those aged 81 to 85 years, and to 9.5% in those aged over 85 years (P = .02). .
Of the total population, 15 patients (0.2%) had invasive adenocarcinoma; among patients with a life expectancy of less than 10 years, 1 of 9 were treated, while 4 of 6 patients with a life expectancy of 10 years or more were treated.
Conclusions and relevance
In this cross-sectional study with a nested cohort, the majority of screening colonoscopies performed in patients older than 75 years were performed in patients with limited life expectancy and were associated with an increased risk of complications. Colorectal cancer was extremely rare.
