Colonoscopy in Inpatient Octogenarians: Beware
Douglas K. Rex, MD, FASGE reviewing Olaiya B, Adler DG. J Clin Gastroenterol 2019 Nov 22.
Population-based studies have consistently shown that the risk of major complications, particularly perforation, are increased in older patients. In an assessment of major colonoscopy complications utilizing the National Inpatient Sample, 437,170 colonoscopies in octogenarians, with a mean age of 84 years, were identified. The risks of perforation, postcolonoscopy bleeding, and splenic injury were 11, 9, and 0.22 per 1000 colonoscopies, respectively. The odds ratios (ORs) for death were increased after perforation (OR, 8.65; 95% confidence interval [CI], 7.83-9.56), postcolonoscopy bleeding (OR, 1.28; 95% CI, 1.04-1.59), and splenic injury (OR, 25.93; 95% CI, 14.61-46.01).
Overall, colonoscopy in persons 80 years of age and older accounted for about 25% of inpatient colonoscopies.
COMMENT
These are stunning incidence rates of complications after colonoscopy in inpatient octogenarians, and the associated mortality indicates these complications are not well tolerated. My own approach is to use pediatric colonoscopes and water filling for insertion in older patients, sometimes switching to adult colonoscopes for therapeutic procedures if it is clear that colonic anatomy is relatively normal. Strict attention to early loop reduction is critical, and trainees need close supervision in this patient population. Additional study is needed to prove what methods can reduce complications in this population.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
CITATION(S)
Olaiya B, Adler DG. Adverse events after inpatient colonoscopy in octogenarians: results from the National Inpatient Sample (1998-2013). J Clin Gastroenterol 2019 Nov 22. (Epub ahead of print) (https://doi.org/10.1097/MCG.0000000000001288)
