Editorial
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World J Gastrointest Endosc. Jun 16, 2014; 6(6): 220-226
Published online Jun 16, 2014. doi: 10.4253/wjge.v6.i6.220
Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits
Otto S Lin
Otto S Lin, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
Otto S Lin, Gastroenterology Division, University of Washington School of Medicine, Seattle, WA 98101, United States
Author contributions: Lin OS wrote the manuscript.
Correspondence to: Otto S Lin, MD, MSc, Gastroenterology Division, University of Washington School of Medicine, C3-Gas, 1100 Ninth Avenue, Seattle, WA 98101, United States. otto.lin@vmmc.org
Telephone: +1-206-6257373 Fax: +1-206-2236379
Received: December 22, 2013
Revised: February 18, 2014
Accepted: May 16, 2014
Published online: June 16, 2014
Processing time: 175 Days and 15.5 Hours
Abstract

Many diagnostic and screening colonoscopies are performed on very elderly patients. Although colonoscopic yield increases with age, the potential benefits in such patients decrease because of shorter life expectancy and more frequent comorbidities. Colonoscopy in very elderly patients carries a greater risk of complications and morbidity than in younger patients, and is associated with lower completion rates and higher likelihood of poor bowel preparation. Thus, screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks and patient preferences. On the other hand, diagnostic and therapeutic colonoscopy are more likely to benefit even very elderly patients, and in most cases should be performed if indicated.

Keywords: Colonoscopy; Elderly; Colon polyp; Colon cancer; Screening; Surveillance; Complications; Yield; Bowel preparation

Core tip: Although colonoscopic yield increases with age, the potential benefits in elderly patients decrease because of shorter life expectancy and more frequent comorbidities. Colonoscopy in very elderly patients carries a greater risk of complications and morbidity than in younger patients. Thus, colonoscopy in elderly patients should be performed only after careful consideration of potential benefits, risks and patient preferences.