Should Older Adults With Adenomas Continue Surveillance Colonoscopy?
Douglas K. Rex, MD, MASGE, reviewing Schoenborn NL, et al. Am J Gastroenterol 2023 Jan 19.
Although there are rules for when to stop colorectal cancer screening, there are no rules about when to stop surveillance colonoscopy in patients with precancerous lesions.
This was a paid survey of 874 physicians who see patients in clinic, including adults aged 65 years or older. Survey respondents included physicians specializing in family medicine/general practice (36.2%), gastroenterology (31.5%), and internal medicine (30.6%).
The survey included questions about continuing surveillance in 12 different scenarios that included patients with ages ranging from 75 to 85 years, varying health of poor, moderate, or good, and low or high adenoma risk.
Age and health had more impact on surveillance recommendations than adenoma risk. Surveillance was recommended by 20.6% of respondents for an 85-year-old versus 49.8% who would recommend it for a 75-year-old. Surveillance recommendation rates according to patient health were 7.1% for patients in poor health, 28.8% for moderate health, and 67.7% for good health. Surveillance was recommended by 29.8% of respondents for patients with low-risk adenomas versus 41.6% for patients with high-risk adenomas.
Family medicine physicians were more likely to continue surveillance (40%) than gastroenterologists (30.9%). Regarding risks versus benefits of surveillance in older adults, 52.3% of primary care physicians versus 35.4% of gastroenterologists expressed uncertainty. When asked whether gastroenterologists should make decisions about surveillance, 71.5% of gastroenterologists versus 32.8% of primary care physicians agreed.
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.
Schoenborn NL, Pollack CE, Gupta S, Boyd CM. Physician decision-making about surveillance in older adults with prior adenomas – results from a national survey. Am J Gastroenterol 2023 Jan 19. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000002193)