COLONOSCOPY FOR THE ELDERLY FROM THE PERSPECTIVE OF ADVANCED NEOPLASIA OCCURRENCE

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[Purpose] This study was designed to assess the implication of total colonoscopy (TCS) for the elderly from the perspective of advanced neoplasia (AVN ; adenomas with a diameter of 10 mm or more and carcinomas) occurrence. [Methods] A total of 2503 patients who underwent the first colonoscopy (CS) with bowel preparation from June 2004 to May 2011 were enrolled. They were stratified into 3 groups by age at CS : 64 years of age or less (younger, n=822) ; 65-84 years (elderly, n=1303) ; and 85 years of age and older (very elderly, n=378). Gender, conscious sedation, supplemental oxygen administration, cecal intubation, intubation time, and occurrence of AVN were analyzed. In the three groups there were 822 patients (male : female, 512 : 310), 1303 (658 : 645) and 378 (116 : 262), respectively. [Results] The incidence of patients who required oxygen administration during sedation significantly increased according to age : 1.7%, 5.4% and 8.4% respectively. The rate of cecal intubation declined ; 97.1%, 93.1% and 83.7%, respectively. The intubation time became prolonged ; 8.7, 10.8 and 13.0 minutes, respectively. A total of 417 AVN lesions were identified in 352 patients. The number of AVNs by histological type was as follows : adenomas, 170 ; carcinomas-in-situ, 92 ; carcinomas with submucosal invasion, 15 ; and advanced carcinomas, 140. The incidence of AVN, advanced carcinoma, proximal (from cecum to transverse colon) AVN, proximal advanced carcinoma and obstructive carcinoma was significantly higher in the very elderly group than in the younger and elderly groups ; 10.8% of patients in the younger, 14.6% in the elderly and 19.3% in the very elderly group had AVN, 4.6%, 5.3% and 8.7% had advanced carcinoma, 4.5%, 5.7% and 8.5% had proximal AVN, 1.1%, 1.7% and 4.5% had proximal advanced carcinoma and 0.5%, 0.8% and 1.6% had obstructive carcinoma, respectively. [Conclusions] For elderly and very elderly people, careful maneuvering during the CS with successful cecal intubation is feasible as well as making a decision to withdraw for fear of critical complications.

COLONOSCOPY FOR THE ELDERLY FROM THE PERSPECTIVE OF ADVANCED NEOPLASIA OCCURRENCE

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