90 岁及以上患者与较年轻患者相比结肠镜检查的风险和获益。

Risks and Benefits of Colonoscopy in Patients 90 Years or Older, Compared With Younger Patients.

机构信息

Gastroenterology Division, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, South Korea; Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.

Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington.

出版信息

Clin Gastroenterol Hepatol. 2016 Jan;14(1):80-6.e1. doi: 10.1016/j.cgh.2015.06.036. Epub 2015 Jul 9.

DOI:10.1016/j.cgh.2015.06.036

PMID:26164224

Abstract

BACKGROUND & AIMS: Although the numbers of medical procedures performed on extremely elderly patients (90 years or older, nonagenarians) are increasing, there are no data on the performance, diagnostic yield, or safety of colonoscopy for these patients. We compared the performance and safety of diagnostic colonoscopy, as well as lesions detected, in nonagenarians with patients who were 75 to 79 years old.

METHODS

In a retrospective study, we compared data from 76 extremely elderly patients (90 years or older) with data from 140 very elderly patients (75 to 79 years old, controls), all of whom underwent diagnostic colonoscopy from January 2010 through March 2013 at Virginia Mason Medical Center. All colonoscopies were performed by 15 endoscopists. We compared rates of colonoscopy completion, bowel preparation quality, diagnostic yield, and adverse events.

RESULTS

In extremely elderly patients, more colonoscopies were performed under general anesthesia, compared with controls (P < .001). When extremely elderly patients underwent colonoscopies with moderate sedation, lower doses of midazolam and fentanyl were given, compared with controls (P < .001). Colonoscopies were completed in a lower proportion of extremely elderly patients (88.2% vs. 99.3% for controls, P < .001), and these patients had a higher incidence of inadequate bowel preparation (29.7% vs. 15.0% for controls, P = .011). Colonoscopies were also associated with cardiopulmonary events in a higher proportion of extremely elderly patients (P = .006) as well as overall adverse events, compared with controls (P = .002). A higher proportion of extremely elderly patients were found to have advanced neoplasia (28.4% vs. 6.4% of controls, P < .001) as well as any neoplasia (P < .001 vs. controls). A greater percentage of extremely elderly patients also had large lesions (P = .002) and malignancies detected by histology (P < .001 vs. controls). Eleven extremely elderly patients (14.9%) were found to have cancer or high-grade dysplasia by colonoscopy.

CONCLUSIONS

In patients 90 years or older, diagnostic colonoscopy is associated with increased risk for incomplete procedure, inadequate bowel preparation, and adverse events. However, a large proportion of patients are found to have advanced neoplasia and cancer, compared with patients 75 to 79 years old.

摘要

背景与目的

尽管接受医疗程序的超高龄患者（90 岁及以上，非 90 岁人群）数量不断增加，但目前尚无针对这些患者的结肠镜检查表现、诊断效果和安全性的数据。我们比较了 90 岁及以上的超高龄患者与 75 至 79 岁的非常高龄患者（对照组）行诊断性结肠镜检查的表现和安全性，以及检查中发现的病变。

方法

我们进行了一项回顾性研究，比较了 2010 年 1 月至 2013 年 3 月在弗吉尼亚梅森医疗中心接受诊断性结肠镜检查的 76 名超高龄患者（90 岁及以上）的数据与 140 名非常高龄患者（75 至 79 岁，对照组）的数据。所有结肠镜检查均由 15 名内镜医生进行。我们比较了结肠镜检查完成率、肠道准备质量、诊断效果和不良事件。

结果

与对照组相比，超高龄患者中更多的结肠镜检查是在全身麻醉下进行的（P<0.001）。当超高龄患者接受中度镇静下的结肠镜检查时，咪达唑仑和芬太尼的剂量较低（P<0.001）。与对照组相比，超高龄患者中完成结肠镜检查的比例较低（88.2% vs. 99.3%，P<0.001），且肠道准备不充分的发生率较高（29.7% vs. 15.0%，P=0.011）。与对照组相比，超高龄患者中结肠镜检查还与更高比例的心肺事件（P=0.006）和总体不良事件相关（P=0.002）。超高龄患者中发现高级别肿瘤的比例较高（28.4% vs. 对照组 6.4%，P<0.001）和任何级别的肿瘤（P<0.001 vs. 对照组）。超高龄患者中也有更大比例的大病变（P=0.002）和组织学发现的恶性肿瘤（P<0.001 vs. 对照组）。11 名超高龄患者（14.9%）通过结肠镜检查发现癌症或高级别异型增生。