Swedish study shows colonoscopies deliver high cancer detection in elderly patients
Researchers analyzed nearly 1,200 colonoscopies in patients over 75 and found colorectal cancer in 5% of cases, with similar diagnostic yields whether patients were hospitalized or treated as outpatients. The findings help healthcare systems justify the procedure's value in aging populations while identifying which elderly patients can safely receive screening in lower-cost outpatient settings.
Originaltitel: Colonoscopy in elderly patients: diagnostic yield, pre-referral assessment and quality indicators in two Swedish cohorts
<p><strong>Objectives</strong>: Colonoscopy in elderly, frail patients requires weighing diagnostic yield against procedure-related risk, but real-world data are limited. We describe outcomes from two Swedish cohorts undergoing non-screening colonoscopy in two regions.</p><p><strong>Methods</strong>: We combined aggregated results from two retrospective cohort studies. The Ersta cohort included all patients aged >= 75 years undergoing colonoscopy in 2022 and compared inpatient versus outpatient examinations. The Örebro cohort included all colonoscopies in patients aged >= 80 years during 2016-2018. We extracted data on indications, pre-referral investigations, findings, quality indicators, and short-term mortality. For Örebro, we used previously calculated odds ratios and positive predictive values for significant findings.</p><p><strong>Results</strong>: At Ersta, 1,066 patients aged >= 75 years underwent 1,144 colonoscopies; 40% were performed in inpatients admitted for bowel preparation. Colorectal cancer was diagnosed in 5%, inflammatory bowel disease in 6%, microscopic colitis in 3%, and other colitis in 4%, with similar proportions in inpatients and outpatients. One-year mortality was 6% after inpatient and 1% after outpatient colonoscopy. In Örebro, 565 colonoscopies in patients aged >= 80 years were analyzed. Significant findings occurred in 26.2% (colorectal cancer 18.8%, high-grade dysplasia 4.6%, any colitis 5.0%, with some overlap). Abnormal rectal examination, abnormal abdominal imaging, low ferritin, and positive f-Hb predicted significant disease. Altered bowel habits was the most common indication but had an odds ratio below 1 for significant disease.</p><p><strong>Conclusions</strong>: In elderly Swedish patients, colonoscopy detects colorectal cancer or colitis, but many examinations show benign or no findings. Selection using simple pre-referral tests and life expectancy may reduce low-yield examinations.</p>