Punjabi, K.; Ishaq, S.; Jammalamadaka, D.; Kuar, S.; Geoghegan, M.; Singh, P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA110
Academic Journal
Introduction: Clinicians are reluctant to refer elderly patients for colonoscopy because of a perception of significant risk of complications and procedural failure in this age group. Methods: Data were collected prospectively over a 2 year period on indications, sedation, crude and adjusted total colonoscopy rates (CTCR and ATCR), ileoscopy rate (IR), anus to caecum time (ACT), and diagnostic yield. For calculation of ATCR, IR and ACT, patients with impassable strictures and previous colonic resection were excluded. 517 procedures were done by a consultant and 99 by trainees independently or under supervision. Results: 66 of 616 patients were aged 80 or over. The median age and interquartile range (IQ) for patients aged 80 and over (0) was 83 (81-86) and 59 (48-70) for those under the age of 80 (Y). The majority received a combination of midazolam (M) and pethidine (P). Older patients received significantly less sedation. The median amount and IQ in mg was 1 (1-2.5) in 0 and 2.5 (1-5) in Y for M, and 12.5 (12.5-25) and 25 (12.5-50) in 0 and Y respectively for P (p < 0.0001). Median ATCR was 98.3% and 99.2% for 0 and Y respectively (ns). IR was significantly lower in the older group (69% vs. 86%, p = 0.0021). There was no significant difference in ACT with median time and IQ in minutes of 8.5 (6.5-12.8) and 8 (5-12) for O and Y, respectively. The chief diagnoses in the two groups are outlined in the Table. There were 7 complications. One 81 year old had a hypoxic episode requiring sedation reversal and abandonment of procedure. The rest were in the younger group: 2 postpolypectomy bleeds requiring transfusion, 2 perforations requiring surgery, and 2 oversedation requiring reversal. No mortalities occurred. The median and IQ of M, P, and ACT were 2.5 (1-2.5), 25 (12.5-50), 7 (5-10) for the consultant and 2.5 (2.5-5), 50 (25-50), 14.5 (10.5-20) for the trainees (p < 0.0001). Conclusion: Colonoscopy in the elderly is safe and effective with a high diagnostic yield...


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