Abdelmessih Rita, Packey Christopher D, Lawlor Garrett
NY-Presbyterian Hospital, Columbia University Medical Center, PH 7, 7th Floor, 622 W168th St, New York, NY, 10032, USA.
Curr Treat Options Gastroenterol. 2016 Sep;14(3):305-14. doi: 10.1007/s11938-016-0101-3.
Performing endoscopic procedures in the elderly carries known enhanced risk compared to the general population. Weighing the benefits against the risks is easy when a patient is in immediate danger, but a gray area arises in screening protocols in an elderly patient of average risk. In this review, we compare national and international guidelines in average risk screening procedures (colonoscopic colorectal screening, Barrett's surveillance) to find consensus for screening practice in the elderly. With minor differences between societal guidelines, it is widely agreed that 75 years is the appropriate age to begin to weigh risks and benefits according to a patient's state of health and comorbidities. For colorectal screening, most guidelines advocate complete cessation of screening after the age of 85 years. Such consensus must take into account an aging population where patients are living healthier for longer and thus may be appropriate candidates for screening procedures even if beyond designated ages of screening cessation.
与普通人群相比，老年患者进行内镜检查的风险已知会增加。当患者处于紧急危险中时，权衡利弊很容易，但在对平均风险的老年患者进行筛查时，就会出现一个灰色地带。在本综述中，我们比较了国内和国际关于平均风险筛查程序（结肠镜结直肠癌筛查、巴雷特食管监测）的指南，以寻求老年患者筛查实践的共识。尽管不同社会指南存在细微差异，但人们普遍认为，75岁是根据患者健康状况和合并症开始权衡风险和收益的合适年龄。对于结直肠癌筛查，大多数指南主张85岁以后完全停止筛查。这样的共识必须考虑到人口老龄化的情况，即患者健康生活的时间更长，因此即使超过指定的筛查停止年龄，也可能是筛查程序的合适候选人。
