Complications and outcomes of routine endoscopy in the very elderly
submitted 22 October 2016
accepted after revision 17 July 2017
07 February 2018 (online)
Background and study aims In Japan, the elderly population has been increasing annually. The number of elderly patients for whom esophagogastroduodenoscopy (EGD) and colonoscopy (CS) is indicated also has been rising. The aim of this study was to evaluate the safety and efficacy of routine endoscopy in a cohort of octogenarians aged 85 years and older – defined by the World Health Organization as the very elderly.
Patients and methods A total of 5,586 patients underwent EGDs, and 2,484 patients underwent CSs performed at the Keio University Hospital from January to September 2014. One hundred eighty-five EGDs and 70 of the CS were performed in the very elderly. Six hundred nine EGDs and 262 CS were performed on younger patients (aged forties). Statistical analysis was performed by univariate and multivariate analyses.
Results On univariate analysis, the rate of adverse events (AEs) in the very elderly was significantly higher compared to the younger group (6.3 % vs. 1.1 %; P < 0.01). Moreover, the very elderly cohort received substantial therapeutic intervention as compared to the younger (16.9 % vs. 6.9 %; P < 0.01). On multivariate analysis, independent risk factors of AEs included: very elderly patients (odds ratio (OR) 3.30, 95 % confidence interval (CI) 1.05 – 10.35), inpatients (OR 3.22, 95 % CI 1.34 – 7.74), and use of pethidine hydrochloride prescription (OR 3.44, 95 % CI 1.51 – 7.81).
Conclusions Routine endoscopy in the very elderly incurs a significant risk of AEs, particularly when combined with pethidine hydrochloride prescription.
- 1 Statistics Bureau, Ministry of Internal Affairs and Communications. Japan Statistical Yearbook 2017. http://www.stat.go.jp/english/data/nenkan/index.htm
- 2 World Health Organization. World Health Report 2013. http://www.who.int/whr/2013/report/en/
- 3 Chukmaitov A, Siangphoe U, Dahman B. et al. Patient Comorbidity and Serious Adverse Events after Outpatient Colonoscopy: Population-based Study From Three States, 2006 to 2009. Dis Colon Rectum 2016; 59: 677-687
- 4 Karajeh MA, Sanders DS, Hurlstone DP. Colonoscopy in elderly people is a safe procedure with a high diagnostic yield: a prospective comparative study of 2,000 patients. Endoscopy 2006; 38: 226-230
- 5 Arora A, Singh P. Colonoscopy in patients 80 years of age and older is safe, with high success rate and diagnostic yield. Gastrointest. Endosc 2004; 60: 408-413 https://seer.cancer.gov/csr/1975_2014/browse_csr.php
- 6 Howlader N, Noone AM, Krapcho M. et al. National Cancer Institute. SEER Cancer Statistics Review(CSR) 1975-2014. https://seer.cancer.gov/csr/1975_2014/
- 7 Buri L, Zullo A, Hassan C. et al. Upper gastrointestinal endoscopy in elderly patients: predictive factors of relevant endoscopic findings. Intern. Emerg Med 2013; 8: 141-146
- 8 Horiuchi A, Nakayama Y, Tanaka N. et al. Propofol sedation for endoscopic procedures in patients 90 years of age and older. Digestion 2008; 78: 20-23
- 9 Qureshi WA, Zuckerman MJ, Adler DG. et al. ASGE guideline: modifications in endoscopic practice for the elderly. Gastrointest Endosc 2006; 63: 566-569
- 10 Zafar HM, Harhay MO, Yang J. et al. Adverse events following computed tomographic colonography compared to optical colonoscopy in the elderly. Prev. Med. Rep 2014; 1: 3-8
- 11 Adachi W, Yazawa K, Owa M. et al. Quantification of cardiac stress during EGD without sedation. Gastrointest Endosc 2002; 55: 58-64
- 12 Benson ME, Byrne S, Brust DJ. et al. EUS and ERCP complication rates are not increased in elderly patients. Dig Dis Sci 2010; 55: 3278-3283
- 13 Lukens FJ, Loeb DS, Machicao VI. et al. Colonoscopy in octogenarians: a prospective outpatient study. Am J Gastroenterol 2002; 97: 1722-1725
- 14 Lee TC, Huang SP, Yang JY. et al. Age is not a discriminating factor for outcomes of therapeutic upper gastrointestinal endoscopy. Hepatogastroenterology 2007; 54: 1319-1322
- 15 Arora G, Mannalithara A, Singh G. et al. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 2009; 69: 654-664
- 16 Ma WT, Mahadeva S, Kunanayagam S. et al. Colonoscopy in elderly Asians: a prospective evaluation in routine clinical practice. J Dig Dis 2007; 8: 77-81
- 17 Clarke GA, Jacobson BC, Hammett RJ. et al. The indications, utilization and safety of gastrointestinal endoscopy in an extremely elderly patient cohort. Endoscopy 2001; 33: 580-584
- 18 Schmilovitz-Weiss H, Weiss A, Boaz M. et al. Predictors of failed colonoscopy in nonagenarians: a single-center experience. J Clin Gastroenterol 2007; 41: 388-393
- 19 Day LW, Kwon A, Inadomi JM. et al. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2011; 74: 885-896
- 20 Moon SH. Sedation regimens for gastrointestinal endoscopy. Clin Endosc 2014; 47: 135-140
- 21 Manolaraki MM, Theodoropoulou A, Stroumpos C. et al. Remifentanil compared with midazolam and pethidine sedation during colonoscopy: a prospective, randomized study. Dig Dis Sci 2008; 53: 34-40
- 22 Abraham NS, Fallone CA, Mayrand S. et al. Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a Canadian randomized controlled cost-outcome study. Am J Gastroenterol 2004; 99: 1692-1699