Background
Studies suggest that advancing age is an independent risk factor for experiencing
adverse events during colonoscopy. Yet many of these studies are limited by small
sample sizes and/or marked variation in reported outcomes.
Objective
To determine the incidence rates for specific adverse events in elderly patients undergoing
colonoscopy and calculate incidence rate ratios for selected comparison groups.
Setting and Patients
Elderly patients undergoing colonoscopy.
Design
Systematic review and meta-analysis.
Main Outcome Measurements
Perforation, bleeding, cardiovascular (CV)/pulmonary complications, and mortality.
Results
Our literature search yielded 3328 articles, of which 20 studies met our inclusion
criteria. Pooled incidence rates for adverse events (per 1000 colonoscopies) in patients
65 years of age and older were 26.0 (95% CI, 25.0-27.0) for cumulative GI adverse
events, 1.0 (95% CI, 0.9-1.5) for perforation, 6.3 (95% CI, 5.7-7.0) for GI bleeding,
19.1 (95% CI, 18.0-20.3) for CV/pulmonary complications, and 1.0 (95% CI, 0.7-2.2)
for mortality. Among octogenarians, adverse events (per 1000 colonoscopies) were as
follows: cumulative GI adverse event rate of 34.9 (95% CI, 31.9-38.0), perforation
rate of 1.5 (95% CI, 1.1-1.9), GI bleeding rate of 2.4 (95% CI, 1.1-4.6), CV/pulmonary
complication rate of 28.9 (95% CI, 26.2-31.8), and mortality rate of 0.5 (95% CI,
0.06-1.9). Patients 80 years of age and older experienced higher rates of cumulative
GI adverse events (incidence rate ratio 1.7; 95% CI, 1.5-1.9) and had a greater risk
of perforation (incidence rate ratio 1.6, 95% CI, 1.2-2.1) compared with younger patients
(younger than 80 years of age). There was an increased trend toward higher rates of
GI bleeding and CV/pulmonary complications in octogenarians but neither was statistically
significant.
Limitations
Heterogeneity of studies included and not all complications related to colonoscopy
were captured.
Conclusions
Elderly patients, especially octogenarians, appear to have a higher risk of complications
during and after colonoscopy. These data should inform clinical decision making, the
consent process, public health policy, and comparative effectiveness analyses.
Abbreviations:
CRC (colorectal cancer), CV (cardiovascular), IRR (incidence rate ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
June 20,
2011
Received:
February 5,
2011
Footnotes
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication. This work was funded in part by grants from the Mount Zion Health Fund and American Society for Gastrointestinal Endoscopy Cook Career Development Award (M.S.) and from the National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK080941) (J.M.I.). Dr. Walter is supported by a VA Health Services Research and Development grant IIR-04-427 and by grant 1R01CA134425 from the National Cancer Institute.
If you would like to chat with an author of this article, you may contact Dr. Day at [email protected]
Identification
Copyright
© 2011 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
