结肠镜检查在老年人中的应用及结果：来自新罕布什尔州结肠镜检查登记处的数据。
Colonoscopy utilization and outcomes in older adults: Data from the New Hampshire Colonoscopy Registry.
机构信息
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Department of Health Policy and Clinical Practice, Dartmouth's Geisel School of Medicine, Hanover, NH, USA.
出版信息
J Am Geriatr Soc. 2022 Mar;70(3):801-811. doi: 10.1111/jgs.17560. Epub 2021 Dec 3.
BACKGROUND
Colonoscopy is frequently performed in older adults, yet data on current use, and clinical outcomes of and follow-up recommendations after colonoscopy in older adults are lacking.
METHODS
This was an observational study using the New Hampshire Colonoscopy Registry of adults age ≥65 years undergoing colonoscopy for screening, surveillance of prior polyps, or evaluation of symptoms. The main outcomes were clinical findings of polyps and colorectal cancer and recommendations for future colonoscopy by age.
RESULTS
Between 2009 and 2019, there were 42,611 colonoscopies, of which 17,527 (41%) were screening, 19,025 (45%) surveillance, and 6059 (14%) for the evaluation of symptoms. Mean age was 71.1 years (SD 5.0), and 49.3% were male. The finding of colorectal cancer was rare (0.71%), with the highest incidence among diagnostic examinations (2.4%). The incidence of advanced polyps increased with patient age from 65-69 to ≥85 years for screening (7.1% to 13.6%; p = 0.05) and surveillance (9.4% to 12.0%; p < 0.001). Recommendations for future colonoscopy decreased with age and varied by findings at current colonoscopy. In patients without any significant findings, 85% aged 70-74 years, 61.9% aged 75-79 years, 39.1% aged 80-84 years, and 27.4% aged ≥85 years (p < 0.001) were told to continue colonoscopy. Among patients with advanced polyps, 97.2% aged 70-74 years, 89.6% aged 75-79 years, 78.4% aged 80-84 years, and 66.7% aged ≥85 years were told to continue colonoscopy (p < 0.001).
CONCLUSIONS
Within this comprehensive statewide registry, clinical findings during colonoscopy varied by indication and increased with age. Overall rates of finding advanced polyps and colorectal cancer are low. Older adults are frequently recommended to continue colonoscopy despite advanced age and insignificant clinical findings on current examination. These data inform the potential benefits of ongoing colonoscopy, which must be weighed with the low but known potential immediate and long-term harms of colonoscopy, including cost, psychological distress, and long lag time to benefit exceeding life expectancy.
背景
结肠镜检查在老年人中经常进行，但缺乏关于老年人结肠镜检查的当前使用情况、临床结果和随访建议的数据。
方法
这是一项观察性研究，使用新罕布什尔州结肠镜检查登记处，纳入年龄≥65 岁的成年人，这些成年人进行结肠镜检查的目的是筛查、监测先前的息肉或评估症状。主要结果是息肉和结直肠癌的临床发现，以及按年龄推荐的未来结肠镜检查建议。
结果
2009 年至 2019 年间，共有 42611 例结肠镜检查，其中 17527 例（41%）为筛查，19025 例（45%）为监测，6059 例（14%）为评估症状。平均年龄为 71.1 岁（标准差 5.0），49.3%为男性。结直肠癌的发现罕见（0.71%），在诊断性检查中发病率最高（2.4%）。随着患者年龄从 65-69 岁增加到≥85 岁，高级别息肉的发生率也有所增加，筛查（7.1%至 13.6%；p=0.05）和监测（9.4%至 12.0%；p<0.001）。基于当前结肠镜检查的结果，未来结肠镜检查的建议随年龄而减少，且因检查结果而异。在没有任何明显发现的患者中，85%的 70-74 岁患者、61.9%的 75-79 岁患者、39.1%的 80-84 岁患者和 27.4%的≥85 岁患者（p<0.001）被告知继续进行结肠镜检查。在有高级别息肉的患者中，97.2%的 70-74 岁患者、89.6%的 75-79 岁患者、78.4%的 80-84 岁患者和 66.7%的≥85 岁患者（p<0.001）被告知继续进行结肠镜检查。
结论
在这个全面的全州范围内的登记处中，结肠镜检查的临床发现因适应证而异，并随年龄增长而增加。高级别息肉和结直肠癌的总体检出率较低。尽管年龄较大且当前检查无明显临床发现，但老年人仍经常被建议继续进行结肠镜检查。这些数据为正在进行的结肠镜检查的潜在获益提供了信息，必须权衡结肠镜检查的低但已知的近期和长期危害，包括成本、心理困扰和获益的长滞后时间超过预期寿命。
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