Clere-Jehl Raphaël, Schaeffer Mickael, Vogel Thomas, Kiesmann Michele, Pasquali Jean-Louis, Andres Emmanuel, Bourgarit Anne, Goichot Bernard
Internal Medicine, Endocrinology and Nutrition Department, Hautepierre Hospital Medical Information and statistics Department, Civil Hospital Geriatric Department, Robertsau Hospital Internal Medicine Department, New Civil Hospital Internal Medicine Department, Civil Hospital, University Hospital of Strasbourg, Strasbourg, France.
Medicine (Baltimore). 2017 Nov;96(44):e8439. doi: 10.1097/MD.0000000000008439.
After age 85, upper and lower gastrointestinal (GI) endoscopy may be indicated in 5% to 10% of inpatients, but the risk-benefit ratio is unknown. We studied patients older than 85 years undergoing upper and lower GI endoscopy.We analyzed a retrospective cohort of inpatients older than 85 years between 2004 and 2012, all explored by upper and complete lower GI endoscopy. Initial indications, including iron deficiency anemia (IDA), other anemias, GI bleeding, weight loss, and GI symptoms, were noted, as were endoscopy or anesthesia complications, immediate endoscopic diagnosis, and the ability to modify the patients' therapeutics. Deaths and final diagnosis for initial endoscopic indication were analyzed after at least 12 months.We included 55 patients, 78% women, with a median age, reticulocyte count, hemoglobin, and ferritin levels of 87 (85-99), 56 (24-214) g/L, 8.6 (4.8-12.9) g/dL, and 56 (3-799) μg/L, respectively. IDA was the most frequent indication for endoscopy (60%; n = 33). Immediate diagnoses were found in 64% of the patients (n = 35), including 25% with GI cancers (n = 14) and 22% with gastroduodenal ulcers or erosions (n = 12). Cancer diagnosis was associated with lower reticulocyte count (45 vs. 60 G/L; P = .02). Among the 35 diagnoses, 94% (n = 33) led to modifications of the patients' therapeutics, with 29% of the patients deciding on palliative care (n = 10). No endoscopic complications lead to death. Follow-up of >12 months was available in 82% (n = 45) of the patients; among these patients, 40% (n = 27) died after an average 24 ± 18 months. Cancer diagnosis was significantly associated with less ulterior red cell transfusion (0% vs. 28%; P = .02) and fewer further investigations (6.7% vs. 40%; P = .02).Upper and complete lower GI endoscopy in patients older than 85 years appears to be safe, and enables a high rate of immediate diagnosis, with significant modifications of therapeutics. GI cancers represented more than one-third of the endoscopic diagnoses.
85岁以后，5%至10%的住院患者可能需要进行上消化道和下消化道（GI）内镜检查，但风险效益比尚不清楚。我们研究了85岁以上接受上消化道和下消化道内镜检查的患者。我们分析了2004年至2012年间85岁以上住院患者的回顾性队列，所有患者均接受了上消化道和完整的下消化道内镜检查。记录了初始指征，包括缺铁性贫血（IDA）、其他贫血、消化道出血、体重减轻和消化道症状，以及内镜检查或麻醉并发症、即时内镜诊断和改变患者治疗方法的能力。至少12个月后分析了初始内镜检查指征的死亡情况和最终诊断。我们纳入了55例患者，其中78%为女性，中位年龄、网织红细胞计数、血红蛋白和铁蛋白水平分别为87（85-99）岁、56（24-214）g/L、8.6（4.8-12.9）g/dL和56（3-799）μg/L。IDA是最常见的内镜检查指征（60%；n = 33）。64%的患者（n = 35）有即时诊断，其中25%为消化道癌症（n = 14），22%为胃十二指肠溃疡或糜烂（n = 12）。癌症诊断与较低的网织红细胞计数相关（45 vs. 60 G/L；P = 0.02）。在35例诊断中，94%（n = 33）导致患者治疗方法的改变，29%的患者决定接受姑息治疗（n = 10）。没有内镜检查并发症导致死亡。82%（n = 45）的患者有超过12个月的随访；在这些患者中，40%（n = 27）在平均24±18个月后死亡。癌症诊断与较少的后续红细胞输血（0% vs. 28%；P = 0.02）和较少的进一步检查（6.7% vs. 40%；P = 0.02）显著相关。85岁以上患者进行上消化道和完整的下消化道内镜检查似乎是安全的，并且能够实现较高的即时诊断率，同时显著改变治疗方法。消化道癌症占内镜诊断的三分之一以上。
