Digestive Diseases Institute, Shaare Zedek Medical Center, affiliated with the Hebrew University, Jerusalem, Israel.
J Am Geriatr Soc. 2019 Jun;67(6):1158-1163. doi: 10.1111/jgs.15832. Epub 2019 Feb 22.
Data regarding colonoscopy in patients older than 90 years old is scarce. Yet the number of colonoscopies done on nonagenarians is rising. We aimed to determine the yield, safety, and therapeutic benefits of colonoscopy in these patients.
Case-control study of older patients who underwent colonoscopy.
Gastroenterology institute at an academic medical center.
Patients older than 90 years (n = 128) compared with patients aged 80 to 89 years (n = 218) who underwent colonoscopy.
Colonoscopy.
Indication for the procedure, completion rates, adequacy of preparation, complications, colonoscopic findings, 30-day mortality, advanced adenoma and carcinoma detection rate, treatment, and long-term survival of patients diagnosed with colorectal cancer.
Mean ages were 83.3 and 92.2 years old. Nonagenarians were more likely to undergo a colonoscopy while hospitalized (56.2 vs 23.4%; P < .001) and to undergo the examination due to rectal bleeding or sigmoid volvulus (35.2 vs 25.2 and 10.9 vs 0.5%, respectively; P < .001) and less likely for surveillance or constipation (11.7 vs 25.7 and 0 vs 6.9%, respectively; P < .001). Completion rates and severe adverse events were comparable. The 30-day mortality was 3.9% in nonagenarians and 0.4% in octogenarians (P = .02). Advanced adenomas and carcinoma were more common in nonagenarians (25.8 vs 16.5%, P = .03, and 14.8 vs 6.4%, P = .01, respectively). Increasing age, inpatient status, past polypectomy surveillance, and anemia were associated with higher rates of carcinoma. Half of the nonagenarians diagnosed with adenocarcinoma underwent surgery compared with 100% of octogenarians (P = .01). Among nonagenarians with colorectal cancer who died, mean survival was 605 (interquartile range = 11-878) days in those who underwent surgery and 112 (48-341) in those treated conservatively (P = .055 log-rank test).
Colonoscopy in nonagenarians has a high yield and is generally safe. Colonoscopy findings lead to surgery in more than half of these patients and was associated with a median survival of 20 months.
关于 90 岁以上患者结肠镜检查的数据很少。然而，对 90 岁以上人群进行结肠镜检查的数量正在增加。我们旨在确定这些患者结肠镜检查的检出率、安全性和治疗益处。
对在学术医疗中心行结肠镜检查的老年患者进行病例对照研究。
胃肠病学研究所。
128 例 90 岁以上（n=128）和 218 例 80 至 89 岁（n=218）行结肠镜检查的患者。
结肠镜检查。
操作适应证、完成率、准备充分程度、并发症、结肠镜检查结果、30 天死亡率、高级腺瘤和癌检出率、治疗以及诊断为结直肠癌患者的长期生存情况。
平均年龄分别为 83.3 岁和 92.2 岁。90 岁以上患者更有可能因住院（56.2%比 23.4%；P<0.001）和直肠出血或乙状结肠扭转（35.2%比 25.2%和 10.9%比 0.5%；P<0.001）而接受结肠镜检查，而不太可能因监测或便秘（11.7%比 25.7%和 0%比 6.9%；P<0.001）而行结肠镜检查。完成率和严重不良事件相当。90 岁以上患者的 30 天死亡率为 3.9%，80 岁以上患者为 0.4%（P=0.02）。90 岁以上患者高级腺瘤和癌更为常见（25.8%比 16.5%，P=0.03，和 14.8%比 6.4%，P=0.01）。年龄增长、住院状态、既往息肉切除监测和贫血与更高的癌发生率相关。一半被诊断为腺癌的 90 岁以上患者接受了手术，而 100%的 80 岁以上患者接受了手术（P=0.01）。在死于结直肠癌的 90 岁以上患者中，接受手术的患者中位生存时间为 605 天（四分位距=11-878），接受保守治疗的患者为 112 天（48-341）（P=0.055 对数秩检验）。
90 岁以上患者行结肠镜检查的检出率较高，且通常安全。结肠镜检查结果导致超过一半的患者接受手术，中位生存时间为 20 个月。
