The study authors reported that this is the first population-based analysis of adverse events after colonoscopy exclusively in elderly people.
Dr. Joan L. Warren at the National Cancer Institute in Bethesda, Maryland, and team reported that these findings support the position of the US Preventive Services Task Force, which does not recommend any type of colorectal screening for individuals ages 75 to 85 years and recommends against screening in those 85 or older.
The researchers studied data collected from 55,220 Medicare beneficiaries aged 66-95 who had outpatient colonoscopies (screening, diagnostic, or with polypectomy) between 2001 and 2005. The patients matched with beneficiaries who did not have colonoscopies.
The authors reported that risks for adverse events after colonoscopy increased with age; specifically, the risk for serious GI events such as perforation or GI bleeding was 75% higher for people aged 80-84 than for those aged 66-69.
In addition, 75 years and more individuals who underwent colonoscopy were at increased risk for adverse GI events compared to the matched controls.
The type of procedure was also considerable. The risk of any GI event that includes milder events such as nausea and vomiting was significantly higher among those who had polypectomies than among those having screening or diagnostic colonoscopies or the matched controls. The polypectomy group were also at significantly higher risk of cardiovascular events such as myocardial infarction or arrhythmias than the other 3 groups.
According to the article, a history of stroke, chronic obstructive pulmonary disease, atrial fibrillation or congestive heart failure put patients at significantly higher risk for serious GI events.
Our findings should aid clinicians in making age- and health status-appropriate recommendations to elderly patients for colorectal cancer screening, the researchers wrote, especially given the availability of Medicare coverage for alternative colorectal cancer screening tests that are less risky than colonoscopy.
