1
|
Chen MZ, Tan M, Walter T, Rich G, Barto W. Colonoscopy in the nonagenarian population. ANZ J Surg 2023; 93:2143-2147. [PMID: 36881524 DOI: 10.1111/ans.18374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND With increasing life expectancy, there is an increasing proportion of nonagenarians undergoing both elective and emergency surgical procedures. The decision as to whom will benefit from surgical procedures is however difficult to ascertain and still remains a challenge to clinicians. This study is aimed to evaluate the clinical outcomes of colonoscopy in the nonagenarian population, and to determine if the outcomes are acceptable for us to continue to offer such interventions. METHODS Retrospective study of patients of Dr. G.R (Gastroenterologist) and Dr. W.B (Colorectal Surgeon) between 1 January 2018 and 31 November 2022. All patients who were ≥90 years old and had a colonoscopy was included in the study. Exclusion criteria were patients who were less than 90 years old, had a flexible sigmoidoscopy or colonoscopy as part of their surgical procedure. PRIMARY OUTCOME MEASURES post-colonoscopy complications and length of stay. SECONDARY OUTCOME MEASURES reasons for colonoscopy, significant colonoscopy findings, 30-day morbidity and mortality. RESULTS Sixty patients were included in the study. Median age was 91 (90-100) years old. 33.3% of the patients were males. Seventy percent of the patients were ASA 3. Median length of hospital stay was 1 day. 11.7% of patients were found to have colorectal malignancy. There were no complications after the colonoscopy. There were no 30-day re-admission, morbidity or mortality. CONCLUSION Colonoscopy can be performed safely in carefully selected nonagenarian patients with acceptable low complication rates.
Collapse
Affiliation(s)
- Michelle Zhiyun Chen
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Min Tan
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Tim Walter
- Department of Gastroenterology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Australian National University, Sydney, New South Wales, Australia
| | - Graeme Rich
- Department of Gastroenterology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Australian National University, Sydney, New South Wales, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Walid Barto
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- Department of Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Choi EJ, Jee SR, Lee SH, Yoon JS, Yu SJ, Lee JH, Lee HB, Yi SW, Kim MP, Chung BC, Lee HS. Effect of music on colonoscopy performance: A propensity score-matched analysis. World J Gastrointest Endosc 2023; 15:397-406. [PMID: 37274560 PMCID: PMC10236976 DOI: 10.4253/wjge.v15.i5.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/02/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Music has been used to reduce stress and improve task performance during medical therapy.
AIM To assess the effects of music on colonoscopy performance outcomes.
METHODS We retrospectively reviewed patients who underwent colonoscopy performed by four endoscopists with popular music. Colonoscopy performance outcomes, such as insertion time, adenoma detection rate (ADR), and polyp detection rate (PDR), were compared between the music and non-music groups. To reduce selection bias, propensity score matching was used.
RESULTS After one-to-one propensity score matching, 169 colonoscopies were selected from each group. No significant differences in insertion time (4.97 vs 5.17 min, P = 0.795) and ADR (39.1% vs 46.2%, P = 0.226) were found between the two groups. Subgroup analysis showed that the insertion time (3.6 vs 3.8 min, P = 0.852) and ADR (51.1% vs 44.7%, P = 0.488) did not significantly differ between the two groups in experts. However, in trainees, PDR (46.9% vs 66.7%, P = 0.016) and ADR (25.9% vs 47.6%, P = 0.006) were significantly lower in the music than in the non-music group.
CONCLUSION The current study found that listening to music during colonoscopy did not affect procedure performance. Moreover, it suggested that music may distract trainees from appropriately detecting adenomas and polyps.
Collapse
Affiliation(s)
- Eun Jeong Choi
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Sam Ryong Jee
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Sang Heon Lee
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Jun Sik Yoon
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Seung Jung Yu
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Jong Hyun Lee
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Han Byul Lee
- Department of Public Health, Ajou University Graduate School of Public Health, Suwon 16499, South Korea
| | - Sang Wook Yi
- Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung 25601, South Korea
| | - Myeong Pyo Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Byung Cheol Chung
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| | - Hong Sub Lee
- Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, South Korea
| |
Collapse
|
3
|
Guittet L, Quipourt V, Aparicio T, Carola E, Seitz JF, Paillaud E, Lievre A, Boulahssass R, Vitellius C, Bengrine L, Canoui-Poitrine F, Manfredi S. Should we screen for colorectal cancer in people aged 75 and over? A systematic review - collaborative work of the French geriatric oncology society (SOFOG) and the French federation of digestive oncology (FFCD). BMC Cancer 2023; 23:17. [PMID: 36604640 PMCID: PMC9817257 DOI: 10.1186/s12885-022-10418-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We have done a systematic literature review about CRC Screening over 75 years old in order to update knowledge and make recommendations. METHODS PUBMED database was searched in October 2021 for articles published on CRC screening in the elderly, and generated 249 articles. Further searches were made to find articles on the acceptability, efficacy, and harms of screening in this population, together with the state of international guidelines. RESULTS Most benefit-risk data on CRC screening in the over 75 s derived from simulation studies. Most guidelines recommend stopping cancer screening at the age of 75. In private health systems, extension of screening up to 80-85 years is, based on the life expectancy and the history of screening. Screening remains effective in populations without comorbidity given their better life-expectancy. Serious adverse events of colonoscopy increase with age and can outweigh the benefit of screening. The great majority of reviews concluded that screening between 75 and 85 years must be decided case by case. CONCLUSION The current literature does not allow Evidence-Based Medicine propositions for mass screening above 75 years old. As some subjects over 75 years may benefit from CRC screening, we discussed ways to introduce CRC screening in France in the 75-80 age group. IRB: An institutional review board composed of members of the 2 learned societies (SOFOG and FFCD) defined the issues of interest, followed the evolution of the work and reviewed and validated the report.
Collapse
Affiliation(s)
- Lydia Guittet
- grid.412043.00000 0001 2186 4076Public Health Unit, CHU Caen NormandieNormandie University, UNICAEN, INSERM U1086 ANTICIPE, Caen, France
| | - Valérie Quipourt
- grid.31151.37Geriatrics Department and Coordination Unit in Oncogeriatry in Burgundy, University Hospital of Dijon, Dijon, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, Université de Paris, Paris, France
| | - Elisabeth Carola
- grid.418090.40000 0004 1772 4275Geriatric Oncology Unit, Groupe Hospitalier Public du Sud de L’Oise, Bd Laennec, 60100 Creil, France
| | - Jean-François Seitz
- grid.411266.60000 0001 0404 1115Department of Digestive Oncology & Gastroenterology, CHU Timone, Assistance Publique-Hôpitaux de Marseille (APHM) & Aix-Marseille-Univ, Marseille, France
| | - Elena Paillaud
- grid.414093.b0000 0001 2183 5849Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, inAP-HP, Paris, France
| | - Astrid Lievre
- grid.414271.5Department of Gastroenterology, INSERM U1242 “Chemistry Oncogenesis Stress Signaling”, University Hospital Pontchaillou, Rennes 1 University, Rennes, FFCD France
| | - Rabia Boulahssass
- grid.410528.a0000 0001 2322 4179Geriatric Coordination Unit for Geriatric Oncology (UCOG), PACA Est CHU de NICE, France; FHU ONCOAGE, Nice, France
| | - Carole Vitellius
- grid.411147.60000 0004 0472 0283Hepato-Gastroenterology Department, Angers University Hospital, Angers, France ,grid.7252.20000 0001 2248 3363HIFIH Laboratory UPRES EA3859, Angers University, SFR 4208, Angers, France
| | - Leila Bengrine
- Department of Medical Oncology, Georges-Francois Leclerc Centre, Dijon, France
| | - Florence Canoui-Poitrine
- grid.412116.10000 0004 1799 3934Public Health Unit, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Sylvain Manfredi
- grid.31151.37Gastroenterology and Digestive Oncology Unit, University Hospital Dijon, INSERM U123-1 University of Bourgogne-Franche-Comté, FFCD (French Federation of Digestive Cancer), Dijon, France
| |
Collapse
|
4
|
Inagaki Y, Yoshida N, Hasegawa D, Kassai K, Yasuda R, Inoue K, Hirose R, Dohi O, Okuda T, Inada Y, Okuda K, Ogiso K, Tomie A, Soga K, Murakami T, Itoh Y. The efficacy and safety of colonoscopy in nonagenarians: A multicenter study. Indian J Gastroenterol 2020; 39:557-564. [PMID: 33057909 DOI: 10.1007/s12664-020-01066-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/15/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The number of colonoscopy (CS) for the elderly is increasing. There are only a few reports focusing on CS among the very elderly aged ≥ 90-y. We aimed to analyze the efficacy of CS and of colorectal cancer (CRC) for patients aged ≥ 90-y. METHODS We retrospectively analyzed consecutive patients aged ≥ 90-y receiving CS at eight institutions from October 2016 to September 2017. Bowel preparation, complications, and endoscopic diagnosis were analyzed. The non-elderly group aged between 50-y and 64-y and elderly group aged between 65-y and 79-y were compared to very-elderly group aged ≥ 90-y. Through propensity score matching of sex and CS indications (symptomatic or asymptomatic), the number of CRC and the treatment in each group were analyzed. RESULTS We analyzed 125 patients receiving 154 colonoscopies (0.9%) in the very-elderly group from among 16,968 cases. Among 92 cases who received bowel-cleansing solution, good preparations were achieved in 94.5%. The rate of CS-related complications was 1.3% (2/154). The rate of CRC in the very-elderly group was 27.2% (34/125), higher than the non-elderly group (7.2%, 9/125, p < 0.01) and elderly group (8.8%, 11/125, p < 0.01). Therapeutic interventions for CRC in the very-elderly group were performed in 73.5% (24/34) patients. The mean survival of 12 patients with CRC resection was 788 days. CONCLUSIONS CS could be performed safely for the very elderly aged ≥ 90-y with careful considerations. CRC was confirmed to be more frequent in this group with over 70% of patients receiving appropriate therapeutic intervention.
Collapse
Affiliation(s)
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Daisuke Hasegawa
- Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan
| | - Kyoichi Kassai
- Department of Gastroenterology, Nishijin Hospital, Kyoto, Japan
| | - Ritsu Yasuda
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takashi Okuda
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Kotaro Okuda
- Department of Gastroenterology, Kyoto Kujyo Hospital, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Akira Tomie
- Department of Gastroenterology, Saiseikai Kyoto Hospital, Kyoto, Japan
| | - Koichi Soga
- Department of Gastroenterology, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Japan Community Health Care Organization, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
5
|
Gül Utku Ö, Karatay E. Immediate unprepared polyethylene glycol‐flush colonoscopy in elderly patients with severe lower gastrointestinal bleeding. Geriatr Gerontol Int 2020; 20:559-563. [DOI: 10.1111/ggi.13903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Özlem Gül Utku
- Department of Gastroenterology Kırıkkale University Kırıkkale Turkey
| | - Eylem Karatay
- Department of Gastroenterology GOP Taksim Education and Research Hospital İstanbul Turkey
| |
Collapse
|
6
|
Kwak MS, Cha JM, Yang HJ, Park DI, Kim KO, Lee J, Shin JE, Joo YE, Park J, Byeon JS, Kim HG. Safety and Efficacy of Low-Volume Preparation in the Elderly: Oral Sulfate Solution on the Day before and Split-Dose Regimens (SEE SAFE) Study. Gut Liver 2019; 13:176-182. [PMID: 30400725 PMCID: PMC6430430 DOI: 10.5009/gnl18214] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The use of a low-volume bowel cleansing agent is associated with a greater willingness to undergo repeat colonoscopy. Oral sulfate solution (OSS) is a recently approved low-volume agent; however, its efficacy and safety in the elderly population remain unclear. We aimed to evaluate the efficacy, safety, and acceptability of the OSS preparation, in comparison to those of a standard polyethylene glycol (PEG; 4 L) preparation, in elderly patients. Methods A multicenter, randomized, investigator-blinded study was conducted. Participants were randomized to receive OSS or 4-L PEG with a split-dose regimen. Bowel cleansing efficacy was assessed using the Boston Bowel Preparation Scale (BBPS). Acceptance, satisfaction, and preparation-related symptoms were recorded. Additionally, blood parameters were analyzed for electrolyte abnormalities and nephrotoxicity. Results A total of 193 patients were analyzed. No group differences in overall bowel cleansing efficacy were observed, with “adequate” preparations achieved in 95.9% (93/97) and 94.8% (91/96) of patients in the OSS and 4L PEG groups, respectively (p=0.747). However, mean BBPS scores for the entire (p=0.010) and right colon (p=0.001) were significantly higher in the OSS group than in the 4-L PEG group. The severity of clinical adverse events and frequency of acute kidney injury were similarly low, and no clinically meaningful electrolyte changes were identified. Self-reported scores regarding amount (p<0.001) and feeling (p=0.007), as well as overall satisfaction (p=0.001) and willingness to repeat the preparation (92.8% vs 67.7%, p<0.001), were significantly better in the OSS group than in the 4-L PEG group. Conclusions In elderly individuals, OSS with a split-dose regimen has greater acceptability and comparable efficacy in bowel cleansing compared to 4-L PEG. (Clinical trials registration number: NCT03112967)
Collapse
Affiliation(s)
- Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyo-Joon Yang
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Suwon, Korea
| | - Dong Il Park
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Suwon, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Lee
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jongha Park
- Department of Internal Medicine, Inje University College of Medicine, Gwangju, Korea
| | - Jeong-Sik Byeon
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea, Gwangju, Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Bloch F, Karoui I, Boutalha S, Defouilloy C, Dubaele JM. Tolerability of Midazolam to treat acute agitation in elderly demented patients: A systematic review. J Clin Pharm Ther 2019; 44:143-147. [PMID: 30666683 DOI: 10.1111/jcpt.12785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/29/2018] [Accepted: 11/18/2018] [Indexed: 12/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Behavioural disorders are difficult to manage in elderly demented patients because of the lack of appropriate drugs or difficulties surrounding the route of administration. The tolerability of Midazolam is well described in the emergency management of agitation for young patients, when administered intramuscularly or intravenously. However, very little data are available on the use of oral Midazolam for this indication and in the elderly population. METHODS A literature review was conducted, and studies were included if involving adults, receiving Midazolam, alone or in combination, whatever the route, dosage or indication and if they reported adverse events related to the use of Midazolam. RESULTS AND DISCUSSION Forty-one articles were included. Eleven different adverse events were identified from the studies. Hypotension and desaturation were the two most frequent adverse events reported. Adverse reactions appear to be more common in older patients but also when Midazolam was used in combination with other drugs. The frequency of these adverse effects was lower than those reported for neuroleptic drugs. WHAT IS NEW AND CONCLUSION The oral route appears to be appropriate to provide a rapid and well-tolerated response. Further studies will be needed to confirm the good tolerance of oral Midazolam in the management of acute agitation in elderly demented patients.
Collapse
Affiliation(s)
- Frédéric Bloch
- Department of Geriatric medicine, University Hospital of Amiens-Picardie, Amiens, France
| | - Ilhem Karoui
- Department of Geriatric medicine, University Hospital of Amiens-Picardie, Amiens, France
| | - Samir Boutalha
- Department of Geriatric medicine, University Hospital of Amiens-Picardie, Amiens, France
| | - Christian Defouilloy
- Department of Geriatric medicine, University Hospital of Amiens-Picardie, Amiens, France
| | - Jean-Marc Dubaele
- Department of Pharmacy, University Hospital of Amiens-Picardie, Amiens, France
| |
Collapse
|
8
|
Taleban S, Toosizadeh N, Junna S, Golden T, Ghazala S, Wadeea R, Tirambulo C, Mohler J. Frailty Assessment Predicts Acute Outcomes in Patients Undergoing Screening Colonoscopy. Dig Dis Sci 2018; 63:3272-3280. [PMID: 29796910 DOI: 10.1007/s10620-018-5129-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colonoscopy is associated with multiple adverse outcomes. With an aging population undergoing colorectal cancer screening, few modalities exist to assess the patient risk prior to colonoscopy. Frailty, the age-related decline in reserve and function across multiple organ systems, predicts poor surgical outcomes, but its role in endoscopy is unclear. AIMS This prospective cohort study assesses the efficacy of frailty in predicting acute colonoscopy outcomes. METHODS Participants aged ≥ 50 years undergoing screening colonoscopy at a tertiary care center were recruited over 2 months ending in July 2017. Frailty was assessed using a validated 20-s upper-extremity frailty test, which measures the capacity of muscle performance. Demographic data, American Society of Anesthesiologists (ASA) status, and Charlson comorbidity index (CCI) were evaluated. Procedure-related adverse events and cardiopulmonary changes during and in the immediate post-procedure period were recorded. Adverse events were stratified into minor and major events. Chi-square and ANCOVA models were used in the analysis. RESULTS Ninety-nine adults (mean age 62.8 years) were enrolled, among which 49 were non-frail and 50 were pre-frail/frail; 50 were female. Overall, 55 participants experienced a total of 87 adverse events. Frailty and ASA status were significantly associated with colonoscopy adverse events (p = 0.01 and p = 0.02, respectively). Age and CCI did not predict colonoscopy outcomes. CONCLUSIONS Compared to age and CCI, frailty status better predicts colonoscopy outcomes in older adults. Among adults undergoing colonoscopy, routine frailty screening should be considered for risk stratification. Additional prospective studies evaluating frailty measurements in endoscopy will further clarify its role in forecasting adverse events.
Collapse
Affiliation(s)
- Sasha Taleban
- College of Medicine, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85718, USA. .,Arizona Center on Aging, University of Arizona, Tucson, AZ, USA.
| | - Nima Toosizadeh
- College of Medicine, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85718, USA.,Arizona Center on Aging, University of Arizona, Tucson, AZ, USA.,College of Engineering, University of Arizona, Tucson, AZ, USA
| | - Shilpa Junna
- College of Medicine, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85718, USA
| | - Todd Golden
- Arizona Center on Aging, University of Arizona, Tucson, AZ, USA
| | - Sehem Ghazala
- College of Medicine, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85718, USA
| | - Rita Wadeea
- College of Medicine, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85718, USA
| | - Coco Tirambulo
- Arizona Center on Aging, University of Arizona, Tucson, AZ, USA
| | - Jane Mohler
- College of Medicine, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85718, USA.,Arizona Center on Aging, University of Arizona, Tucson, AZ, USA.,College of Engineering, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
9
|
Cabadas Avión R, Leal Ruiloba MS, Vázquez López S, Ojea Cendón M, Wi Hijazi I, Baluja González MA, Álvarez-Escudero J. A descriptive monitoring study of a non-anesthetist sedation quality program. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 111:55-62. [PMID: 30424678 DOI: 10.17235/reed.2018.5763/2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION sedation substantially improves the quality of digestive endoscopy procedures but may result in severe complications. METHODS a joint commission-based multidisciplinary protocol was used to define a protocol for sedation by non-anesthesiologists. ASA 4 patients were excluded, as well as patients with a difficult airway, complex procedures and deep sedation. Quality based on the analysis of 9 indicators were monitored. Incomplete procedures were also monitored in order to assess efficacy. RESULTS patient safety was established based on a very low incidence of complications and a rate of respiratory events of 1.07. Furthermore, a low rate of hypotension and bradycardia was found, as well as a low rate of pain, either during or after endoscopy and an incidence of unexpected admissions lower than 0.5%. The quality indicators measured reflect the evolution of the results of the program. CONCLUSIONS ongoing sedation program monitoring in endoscopy allows the control of different quality dimensions and the implementation of steps for process improvement.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Julián Álvarez-Escudero
- Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela. Universidad de Santiago de Compostela, España
| |
Collapse
|
10
|
Miyanaga R, Hosoe N, Naganuma M, Hirata K, Fukuhara S, Nakazato Y, Ojiro K, Iwasaki E, Yahagi N, Ogata H, Kanai T. Complications and outcomes of routine endoscopy in the very elderly. Endosc Int Open 2018; 6:E224-E229. [PMID: 29423432 PMCID: PMC5802997 DOI: 10.1055/s-0043-120569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 07/17/2017] [Indexed: 12/16/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | - Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Yoshihiro Nakazato
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Keisuke Ojiro
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan.
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.,Corresponding author Takanori Kanai, MD, PhD Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of Medicine, Keio University35 ShinanomachiShinjuku, Tokyo 160-8582, Japan+81-3-3357-2778
| |
Collapse
|
11
|
Kim HG. Is Elderly Age a Simple Predictive Factor for Inadequate Bowel Preparation before Colonoscopy? Gut Liver 2017; 10:489-90. [PMID: 27377735 PMCID: PMC4933402 DOI: 10.5009/gnl16203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Hyun Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Risks and Benefits of Colonoscopy in Patients 90 Years or Older, Compared With Younger Patients. Clin Gastroenterol Hepatol 2016; 14:80-6.e1. [PMID: 26164224 DOI: 10.1016/j.cgh.2015.06.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although the numbers of medical procedures performed on extremely elderly patients (90 years or older, nonagenarians) are increasing, there are no data on the performance, diagnostic yield, or safety of colonoscopy for these patients. We compared the performance and safety of diagnostic colonoscopy, as well as lesions detected, in nonagenarians with patients who were 75 to 79 years old. METHODS In a retrospective study, we compared data from 76 extremely elderly patients (90 years or older) with data from 140 very elderly patients (75 to 79 years old, controls), all of whom underwent diagnostic colonoscopy from January 2010 through March 2013 at Virginia Mason Medical Center. All colonoscopies were performed by 15 endoscopists. We compared rates of colonoscopy completion, bowel preparation quality, diagnostic yield, and adverse events. RESULTS In extremely elderly patients, more colonoscopies were performed under general anesthesia, compared with controls (P < .001). When extremely elderly patients underwent colonoscopies with moderate sedation, lower doses of midazolam and fentanyl were given, compared with controls (P < .001). Colonoscopies were completed in a lower proportion of extremely elderly patients (88.2% vs. 99.3% for controls, P < .001), and these patients had a higher incidence of inadequate bowel preparation (29.7% vs. 15.0% for controls, P = .011). Colonoscopies were also associated with cardiopulmonary events in a higher proportion of extremely elderly patients (P = .006) as well as overall adverse events, compared with controls (P = .002). A higher proportion of extremely elderly patients were found to have advanced neoplasia (28.4% vs. 6.4% of controls, P < .001) as well as any neoplasia (P < .001 vs. controls). A greater percentage of extremely elderly patients also had large lesions (P = .002) and malignancies detected by histology (P < .001 vs. controls). Eleven extremely elderly patients (14.9%) were found to have cancer or high-grade dysplasia by colonoscopy. CONCLUSIONS In patients 90 years or older, diagnostic colonoscopy is associated with increased risk for incomplete procedure, inadequate bowel preparation, and adverse events. However, a large proportion of patients are found to have advanced neoplasia and cancer, compared with patients 75 to 79 years old.
Collapse
|
13
|
Abstract
Colorectal cancer is common worldwide, and the elderly are disproportionately affected. Increasing age is a risk factor for the development of precancerous adenomas and colorectal cancer, thus raising the issue of screening and surveillance in older patients. Elderly patients are a diverse and heterogeneous group, and special considerations such as comorbid medical conditions, functional status and cognitive ability play a role in deciding on the utility of screening and surveillance. Colorectal cancer screening can be beneficial to patients, but at certain ages and under some circumstances the harm of screening outweighs the benefits. Increasing adverse events, poorer bowel preparation and more incomplete examinations are observed in older patients undergoing colonoscopy for diagnostic, screening and surveillance purposes. Decisions regarding screening, surveillance and treatment for colorectal cancer require a multidisciplinary approach that accounts not only for the patient’s age but also for their overall health, preferences and functional status. This review provides an update and examines the challenges surrounding colorectal cancer diagnosis, screening, and treatment in the elderly.
Collapse
Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center CA, USA
| | - Fernando Velayos
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
14
|
Abstract
OPINION STATEMENT Colorectal cancer (CRC) disproportionately affects the elderly. Older age is a strong risk factor for both the development of precancerous adenomas and CRC, thus raising the issue of screening and surveillance in older patients. However, screening and surveillance decisions in the elderly can be complex and challenging. Elderly patients are a diverse and heterogeneous group and special considerations such as co-morbid medical conditions, functional status, and cognitive ability play a role in one's decisions regarding the utility of screening and surveillance. Such considerations also play a role in factors related to screening modalities, such as colonoscopy, as well as CRC treatment options and regimens. This review addresses many of the unique factors associated with CRC of the elderly and critically examines many of the controversies and challenges surrounding CRC in older patients.
Collapse
Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, 3D-5, San Francisco, CA, 94110, USA,
| | | |
Collapse
|
15
|
Sulu B, Yildiz BD, Buyukuysal C, Demir E, Gunerhan Y. Comparison of Meperidine Versus Hyoscine During Colonoscopy in the Elderly: A Prospective Randomized Study. J Laparoendosc Adv Surg Tech A 2012; 22:631-4. [DOI: 10.1089/lap.2012.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Barlas Sulu
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Baris Dogu Yildiz
- General Surgery Clinic, Ankara Numune Teaching Hospital, Ankara, Turkey
| | - Cagatay Buyukuysal
- Department of Biostatistics, Zonguldak Karaelmas University Faculty of Medicine, Zonguldak, Turkey
| | - Elif Demir
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Yusuf Gunerhan
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
| |
Collapse
|
16
|
Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2011; 74:885-96. [PMID: 21951478 PMCID: PMC3371336 DOI: 10.1016/j.gie.2011.06.023] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 06/20/2011] [Indexed: 02/06/2023]
Abstract
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.
Collapse
|
17
|
Day LW, Walter LC, Velayos F. Colorectal cancer screening and surveillance in the elderly patient. Am J Gastroenterol 2011; 106:1197-206;quiz 1207. [PMID: 21519362 DOI: 10.1038/ajg.2011.128] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Older age is associated with a rise in colorectal cancer and adenomas, necessitating the need for CRC screening in older patients. However, decisions about CRC screening and surveillance in older adults are often difficult and challenging. The decision requires an individualized assessment that incorporates factors unique to performing colonoscopy in older adults in order to weigh the risks and benefits for each patient according to their overall health and preferences. This review addresses the factors unique to colorectal cancer and performing colonoscopy in older adults that are relevant in weighing the risks and benefits of screening and surveillance in this population.
Collapse
Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA.
| | | | | |
Collapse
|