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Gonai T, Toya Y, Kudara N, Abe K, Sawaguchi S, Fujiwara T, Eizuka M, Hirai M, Miura M, Urushikubo J, Yamada S, Kumei T, Yamaguchi S, Sugai K, Asakura K, Orikasa S, Matsumoto T. Is bowel preparation necessary for early colonoscopy in patients with suspected colonic diverticular bleeding?: A multicenter retrospective study with propensity score matching analysis. DEN OPEN 2024; 4:e311. [PMID: 37927949 PMCID: PMC10622738 DOI: 10.1002/deo2.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/12/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
Objectives There are few reports on bowel preparation for early colonoscopy in patients with suspected colonic diverticular bleeding (CDB). We aim to clarify in a retrospective, multicenter study. Methods In a multicenter retrospective cohort study at 10 institutions, we analyzed clinical features of patients diagnosed with CDB, who underwent early colonoscopy within 24 h. We compared patients who were prepared with polyethylene glycol lavage (PEL) and those without PEL. We evaluated the effects of PEL for early colonoscopy in patients with suspected CDB. Results A total of 129 (53%) underwent under preparation with PEL and 113 patients without PEL. The PEL group was younger, had fewer comorbidities, and had better performance status. After adjusting for these variables with propensity score matching, the PEL group had a significantly shorter hospital stay (7.9 ± 4.7 vs. 10.1 ± 5.2 days; p = 0.001), and a higher cecal intubation rate (91.1% vs. 50.0%; p < 0.001). There were no significant differences in adverse event rates, identification of stigmata of recent hemorrhage, or frequency in endoscopic hemostatic treatment. Conclusions PEL may be preferred for early colonoscopy in patients suspected of having CDB.
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Affiliation(s)
- Takahiro Gonai
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineIwate Medical University School of MedicineIwateJapan
- Department of GastroenterologyIwate Prefectural Kuji HospitalIwateJapan
| | - Yosuke Toya
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineIwate Medical University School of MedicineIwateJapan
| | - Norihiko Kudara
- Department of GastroenterologyIwate Prefectural Ofunato HospitalIwateJapan
| | - Keinosuke Abe
- Department of GastroenterologyIwate Prefectural Miyako HospitalIwateJapan
| | - Sera Sawaguchi
- Department of GastroenterologyIwate Prefectural Miyako HospitalIwateJapan
| | - Takao Fujiwara
- Department of GastroenterologyMorioka Red Cross HospitalIwateJapan
| | - Makoto Eizuka
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineIwate Medical University School of MedicineIwateJapan
- Department of GastroenterologyHachinohe Red Cross HospitalAomoriJapan
| | - Minami Hirai
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineIwate Medical University School of MedicineIwateJapan
- Department of GastroenterologyHachinohe Red Cross HospitalAomoriJapan
| | - Manami Miura
- Department of GastroenterologyIwate Prefectural Ninohe HospitalIwateJapan
| | - Jun Urushikubo
- Department of GastroenterologyIwate Prefectural Ninohe HospitalIwateJapan
| | - Shun Yamada
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineIwate Medical University School of MedicineIwateJapan
- Department of GastroenterologyNoshiro Kosei Medical CenterAkitaJapan
| | - Tomo Kumei
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineIwate Medical University School of MedicineIwateJapan
- Department of GastroenterologyNoshiro Kosei Medical CenterAkitaJapan
| | | | - Kyohei Sugai
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineIwate Medical University School of MedicineIwateJapan
- Department of GastroenterologyKazuno Kosei HospitalAkitaJapan
| | - Kensuke Asakura
- Department of GastroenterologyIwate Prefectural Kuji HospitalIwateJapan
| | - Shunsuke Orikasa
- Department of GastroenterologyKitakami Saiseikai HospitalIwateJapan
| | - Takayuki Matsumoto
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineIwate Medical University School of MedicineIwateJapan
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Zhang Y, Wang L, Wu W, Zhang S, Zhang M, She W, Cheng Q, Chen N, Fan P, Du Y, Song H, Hu X, Zhang J, Ding C. Predictors of inadequate bowel preparation in older patients undergoing colonoscopy: A systematic review and meta-analysis. Int J Nurs Stud 2024; 149:104631. [PMID: 37963423 DOI: 10.1016/j.ijnurstu.2023.104631] [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: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Factors that predict the quality of bowel preparation in older adults are unclear, and current guidelines do not provide specific recommendations. OBJECTIVE This meta-analysis aimed to identify risk factors for inadequate bowel preparation in older patients. METHODS PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were searched from their inception to February 2023. Cohort and cross-sectional studies exploring the risk factors for inadequate bowel preparation were included in this systematic review. Odds ratio (OR) values from individual studies were pooled using fixed-effects and random-effects models. In addition, a sensitivity analysis and assessment of publication bias were performed. RESULTS This meta-analysis included six studies (n = 1553) on previous abdominal surgery, six studies (n = 1494) on constipation, seven studies (n = 1505) on diabetes, eight studies (n = 2093) on non-compliance with the diet regimen, seven studies (n = 1350) on incomplete intake of laxative, and nine studies (n = 2163) on inadequate exercise during preparation. The pooled analysis showed that history of abdominal surgery (OR = 2.72; 95 % confidence interval, CI: 2.07 to 3.56), constipation (OR = 3.56, 95 % CI: 2.41 to 5.25), diabetes (OR = 2.54, 95 % CI: 1.81 to 3.57), non-compliance with the diet regimen (OR = 2.51, 95 % CI: 1.96 to 3.21), incomplete intake of laxative (OR = 2.43, 95 % CI: 1.60 to 3.67), and inadequate exercise during preparation (OR = 3.13, 95 % CI: 2.39 to 4.11) were independent risk factors for inadequate bowel preparation in older patients undergoing colonoscopy. CONCLUSIONS Three comorbid factors and three behavioral factors were significantly associated with inadequate bowel preparation in older adults. This meta-analysis provides valuable information for developing predictive models of poor bowel preparation.
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Affiliation(s)
- Yuanyuan Zhang
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Lining Wang
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia
| | - Wenbi Wu
- School of Nursing, Dalian Medical University, Dalian 116044, Liaoning, China
| | - Shi Zhang
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Min Zhang
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Wenjing She
- Department of Nursing, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu, China
| | - Qianqian Cheng
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Nana Chen
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Pengxia Fan
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Yuxin Du
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Haiyan Song
- Department of Nursing, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Xianyu Hu
- Department of Cardiology, The First People's Hospital of Kunshan, Suzhou 215300, Jiangsu, China
| | - Jiajie Zhang
- Department of Nursing, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Caiyan Ding
- Nursing Teaching and Research Department, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu, China.
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Shekleton FE, Baker WC, Courtney ED. Post-operative Surveillance Following Curative Resection of Colorectal Cancer in the Elderly Population in the United Kingdom: An Observational Study. Cureus 2023; 15:e49072. [PMID: 38125234 PMCID: PMC10730949 DOI: 10.7759/cureus.49072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/23/2023] Open
Abstract
Background Colorectal cancer most commonly affects the elderly population. Post-colorectal cancer surveillance aims to reduce cancer incidence and mortality, but its necessity and effectiveness are debated, especially in the elderly population. This study explores the relevance of computer tomography (CT) and colonoscopy surveillance in patients aged 75 and over who have undergone curative resection for colorectal cancer. Methods A retrospective analysis of prospectively collected data was conducted on patients aged 75 and over who had undergone surgical resection of colorectal cancer between November 2014 and August 2021. Data on demographics, treatment, survival, and surveillance were gathered from electronic patient records. The primary outcome was adherence to follow-up colonoscopy and CT-scan surveillance following surgery. Results A total of 417 patients underwent colorectal cancer surgery, with 334 included for analysis. The cohort had an average age of 81 years, with the majority receiving laparoscopic surgery and primary anastomosis. Twelve-month CT surveillance showed normal results in 281 patients (91.8%), while 24-month CT surveillance demonstrated normal findings in 244 patients (88.7%). Only 175 patients (52.4%) had colonoscopy follow-up, with 94 (53.7%) showing normal results, 74 (42.3%) demonstrating benign polyps, and two patients (1.1%) having histologically proven cancer. Reasons for not undergoing colonoscopy included declining invitations (30 patients, 19.1%) and being too frail (45 patients, 28.7%). Conclusion This study reinforces the notion that colonoscopy surveillance for patients over the age of 75 may have limited benefits. In an ageing population, the benefits of surveillance in terms of early detection of recurrence must be balanced against the risks of harm from the procedure, the availability of further management, cost-effectiveness, and patient preferences. An individualised approach should be adopted, potentially with colonoscopy surveillance only recommended in patients of higher risk (extramural venous invasion (EMVI)) and a low frailty score with a life expectancy over 10 years.
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Zhang YY, Vimala R, Chui PL, Hilmi IN. A Systematic Review of Exercise Therapy for Bowel Preparation: Evidence to Guide Practice. Gastroenterol Nurs 2023; 46:393-403. [PMID: 37347807 DOI: 10.1097/sga.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023] Open
Abstract
This systematic review aims to evaluate (1) the effectiveness of exercise therapy in bowel preparation for colonoscopy, and (2) the characteristics of exercise programs for bowel preparation. Systematic searches were done in PubMed, EMBASE, the Cochrane Library, Web of Science, and CINAHL from inception to November 2022. Randomized controlled trials and quasi-experimental studies assessing the efficacy of exercise during bowel preparation were included in this review. Two reviewers independently assessed the methodological quality using a modified Downs and Black checklist. A narrative synthesis was conducted. A total of five studies (1,109 participants) were included in this review. In all eligible studies, the characteristics of the exercise programs varied and included mainly two types of exercise (walking and yoga), various amount of exercise (3,000-10,000 steps or 0.5-1.9 hours), and two exercise timing (during and 1 hour after taking the laxative). Available evidence indicated that exercise therapy is effective in improving the quality of bowel preparation. However, there was insufficient high-quality evidence to conclude the effects on procedure-related indicators, adverse events, and willingness to repeat preparation. Exercise should be recommended as an important part of routine bowel preparation for patients undergoing colonoscopy to improve the quality of bowel preparation. More rigorous studies focusing on the effects on procedure-related indicators, adverse events, and willingness to repeat preparation are needed. To ensure the effectiveness and safety of the intervention, it is critical to establish a standard, well-structured exercise program for bowel preparation.
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Affiliation(s)
- Yuan-Yuan Zhang
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ramoo Vimala
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ping Lei Chui
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ida Normiha Hilmi
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Shahini E, Sinagra E, Vitello A, Ranaldo R, Contaldo A, Facciorusso A, Maida M. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol 2023; 29:1685-1707. [PMID: 37077514 PMCID: PMC10107216 DOI: 10.3748/wjg.v29.i11.1685] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.
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Affiliation(s)
- Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Bari 70013, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù 90015, Italy
| | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| | - Rocco Ranaldo
- Department of Internal Medicine, “Mazzolani-Vandini” Hospital, Digestive Endoscopy, Ferrara 744011, Italy
| | - Antonella Contaldo
- Gastroenterology Unit, National Institute of Gastroenterology “S de Bellis” Research Hospital, Bari 70013, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, Foggia 71122, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
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Poor Health Literacy and Medication Burden Are Significant Predictors for Inadequate Bowel Preparation in an Urban Tertiary Care Setting. J Clin Gastroenterol 2019; 53:e382-e386. [PMID: 30789854 DOI: 10.1097/mcg.0000000000001177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
GOALS The goal of this study was to identify factors impacting the quality of bowel preparation in an urban tertiary care setting. BACKGROUND Inadequate bowel preparation is encountered in 17% to 32% of colonoscopies performed in the United States. Suboptimal colonic visualization reduces the yield of screening colonoscopies and increases healthcare costs because of longer procedure times and aborted procedures. STUDY We performed a cross-sectional survey in patients undergoing outpatient colonoscopy within the Johns Hopkins Health System. A Boston Bowel Preparation Score (BBPS) score of <5 was considered inadequate. Fisher's exact, χ tests and univariate and multivariate binary logistic regression were performed to assess the strength of the association for selected factors with a BBPS<5. RESULTS In total, 467 patients (76.3% response rate) completed the survey between August 2017 and October 2017. The median BBPS score was 7, and 81.4% of patients had an adequate bowel preparation (BBPS≥5). There was significant association between bowel preparation adequacy and level of education, health literacy, functional status, income, and medication burden. When adjusted for other factors, poor confidence in filling forms (OR, 24.1; P<0.001), multiple daily prescription medications (OR, 12.49; P=0.02) and poor functional status (OR, 2.82; P=0.03) had the highest odds of predicting inadequate bowel preparation. CONCLUSIONS Inadequate bowel preparation is a significant problem accounting for reduced yield of screening and increased health care costs. Poor health literacy, functional status, and number of daily medications are significant factors predicting inadequate bowel preparation in the tertiary care setting.
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Maratt JK, Calderwood AH. Colorectal Cancer Screening and Surveillance Colonoscopy in Older Adults. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2019; 17:292-302. [PMID: 30969399 PMCID: PMC6584566 DOI: 10.1007/s11938-019-00230-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The purpose of this chapter is to highlight current recommendations regarding colorectal cancer (CRC) screening and post-polypectomy surveillance colonoscopy in older adults and to review the available literature in order to help inform decision-making in this age group. RECENT FINDINGS Age is a risk factor for CRC; however, older adults with a history of prior screening are at lower risk for CRC compared to those who have never been screened. Decision-making for CRC screening and post-polypectomy surveillance colonoscopy in older adults is complex and several factors including age, screening history, comorbidities, functional status, bowel preparation, prior experiences, preferences, and barriers need to be considered when weighing risks and benefits. Recent guidelines have started to incorporate life expectancy and prior screening history into their recommendations; however, how to incorporate these factors into actual clinical practice is less clear. There are limited data on the relative benefits of screening and surveillance in older adults and therefore, at this time, decision-making should be individualized and incorporate patient preferences in addition to medical factors.
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Affiliation(s)
- Jennifer K Maratt
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Audrey H Calderwood
- Section of Gastroenterology, Department of Medicine, Dartmouth Geisel School of Medicine and the Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center Drive, Lebanon, NH, 03756, USA.
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Neilson LJ, Thirugnanasothy S, Rees CJ. Colonoscopy in the very elderly. Br Med Bull 2018; 127:33-41. [PMID: 29868786 DOI: 10.1093/bmb/ldy018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 05/16/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Colonoscopy is the gold standard test for investigating lower gastrointestinal symptoms and is an important therapeutic tool for colonic polypectomy. This paper is aimed at the general physician and examines the role of colonoscopy in very elderly patients by exploring the particular risks in this population, the yield of colonoscopy and potential alternative investigations. SOURCES OF DATA Original research and review articles were identified through selective PubMed searches. Guidelines were identified through interrogation of national and international society websites in addition to PubMed searches. AREAS OF AGREEMENT Advanced age alone is not a reason to avoid investigation. The decision to perform colonoscopy in this population must take into account indication and yield, risks of the procedure and bowel preparation, physical fitness of the patient, potential alternative and the ability to consent. As a general rule, the principle of 'first doing no harm' should be applied and requires balancing of the risks of the procedure and preparation with the benefits of doing the test. AREAS OF CONTROVERSY There is no defined upper age limit at which colonoscopy is contraindicated, however; the National Health Service Bowel Cancer Screening Programme stops inviting patients for screening and surveillance colonoscopy at age 75. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH The concepts of 'first do no harm' and shared decision-making are not new but are increasingly important, particularly in this patient group. It is crucial to provide patients with information about risks, benefits and alternative investigations to empower their decision-making.
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Affiliation(s)
- L J Neilson
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK.,Northern Region Endoscopy Group (NREG), Newcastle-upon-Tyne, UK
| | - S Thirugnanasothy
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - C J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK.,Northern Region Endoscopy Group (NREG), Newcastle-upon-Tyne, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
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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
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