Surveillance Colonoscopy Recommended Too Often in Older Patients With Limited Life Expectancy
Douglas K. Rex, MD, MASGE, reviewing Calderwood AH, et al. JAMA Intern Med 2023 Mar 13.
Colonoscopists are advised to consider age, comorbidities, and colonoscopy findings before recommending surveillance.
In a study of the New Hampshire Colonoscopy Registry, 9831 adults older than 65 years (mean age, 73.2 years; 53.8% male) undergoing surveillance colonoscopy were evaluated according to colonoscopy findings, recommendations for surveillance, and life expectancy.
Investigators found that life expectancy was 10 years or more in 57.5% of the patients, 5 to 9 years in 35.0%, and less than 5 years in 7.5% of patients. They also discovered that 7.8% of patients had advanced polyps and 0.2% had colorectal cancer.
Among patients with no polyps or only small hyperplastic polyps, the investigators found that surveillance colonoscopy was recommended for 58.1% of those with a life expectancy of less than 5 years, 74.8% of those with a life expectancy of 5 to 9 years, and 95.2% with a life expectancy of at least 10 years. Among patients with only nonadvanced polyps, 60% with a life expectancy of less than 5 years received a surveillance recommendation.
COMMENTThese data indicate that colonoscopists do consider age and comorbidities in deciding to make a surveillance recommendation versus stopping surveillance, but there are not enough recommendations to stop surveillance in patients with no or low-risk findings and limited life expectancy.
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.
CITATION(S)
Calderwood AH, Tosteson TD, Wang Q, Onega T, Walter LC. Association of life expectancy with surveillance colonoscopy findings and follow-up recommendations in older adults. JAMA Intern Med 2023 Mar 13. (Epub ahead of print) (https://doi.org/10.1001/jamainternmed.2023.0078)
