Adverse Events Post-Colonoscopy Rise With Age but Are Rare
METHODOLOGY:
Guidelines recommend surveillance colonoscopy for patients with precancerous adenomas due to an increased colorectal cancer risk but lack recommendations for stopping surveillance after the age of 75 years despite older adults experiencing increased comorbidities.
Researchers analyzed data from 84,172 surveillance colonoscopies performed from 2010 to 2019 within a large integrated US healthcare system.
Participants (59.5% men; 66.4% White individuals), aged 45-85 years, had a prior adenoma and were followed up to 30 days post-procedure for adverse events.
Outcomes included emergency department visits, hospitalizations, and deaths due to specific conditions (eg, colonic perforation and stroke), cardiovascular conditions, or any cause.
Logistic regression was used to assess the association between age and adverse event risk, adjusting for various factors.
TAKEAWAY:
Adverse events occurred in < 1% of procedures, with gastrointestinal bleeding being the most common.
Adverse event rates increased with age, with the highest rates observed in patients aged 76-85 years (69.6 events per 10,000 procedures), particularly for gastrointestinal bleeding (39.2 events per 10,000 procedures) and stroke (18.3 events per 10,000 procedures).
Patients aged 76-85 years had significantly higher odds of adverse events than younger age groups in unadjusted analyses, but these odds were attenuated after adjusting for covariates.
Significant risk factors for adverse events across all age groups included anticoagulant use, higher comorbidity scores, polypectomy, and advanced neoplasia detection during surveillance colonoscopy.
IN PRACTICE:
'The findings suggest that the decision to perform colonoscopy surveillance after age 75 should be individualized based on patient preference, prior colonoscopy findings and procedure quality, comorbidities, and medication usage, rather than age alone,' the authors wrote.
SOURCE:
This study was led by Jeffrey K. Lee, MD, Kaiser Permanente Northern California in Oakland, California. It was published online in Clinical Gastroenterology and Hepatology .
LIMITATIONS:
Findings may not be generalizable, as all participants were insured and had access to comprehensive care. The observational design lacked a noncolonoscopy comparison group, making it difficult to attribute adverse events directly to the procedure. Limited numbers of certain adverse events resulted in wide CIs, and potential confounders like polyp size or number and sedation type were not adjusted for.
DISCLOSURES:
This study was conducted within the National Cancer Institute-funded Population-based Research to Optimize the Screening Process consortium and supported by a career development grant from the same agency. The authors reported no relevant conflicts of interest.
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