{"id":669,"date":"2015-04-10T15:56:44","date_gmt":"2015-04-10T15:56:44","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=669"},"modified":"2017-08-21T11:51:18","modified_gmt":"2017-08-21T11:51:18","slug":"primary-care-corner-with-geoffrey-modest-md-risks-of-colonoscopy-in-older-people","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/04\/10\/primary-care-corner-with-geoffrey-modest-md-risks-of-colonoscopy-in-older-people\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Risks of colonoscopy in older people"},"content":{"rendered":"

By: Dr. Geoffrey Modest<\/strong><\/p>\n

The medical literature has been pretty clear for the past few decades that there are significantly increased risks and decreased benefits from doing screening colonoscopy in older people. The Massachusetts Board of Registration in Medicine just published a document highlighting this point (see here<\/a>).<\/p>\n

\"Untitled\"<\/a><\/p>\n

 <\/p>\n

Details:<\/p>\n

–baseline risk of colonoscopy\u00a0in general population: 4 perforations and 25 serious complications per 10,000 procedures<\/p>\n

–patients 80-84 years old have 75% higher risk than those 65-69, overall about\u00a01% increase per year of age; risks also increase with comorbidities (eg diabetes, stroke, CHF, COPD, atrial fibrillation). \u00a0For example, screening colonoscopies might\u00a0be beneficial up to age 84 in those without comorbidities, yet benefits are uncertain in those 67-69 with >2 comorbidities.<\/p>\n

–bowel prep is more problematic in the elderly. Harder to get a good clean-out, harder to get an adequate test, and increased need for repeat testing (and, I\u00a0would imagine, higher risk of perforation based on the poor prep)<\/p>\n

–those who have had a previous\u00a0negative screen are less likely to develop adenomas\/cancer, and have less need for repeat (there have been analyses done showing that the risk of cancer is much less even 15 years after a negative colonoscopy)<\/p>\n

–one can also\u00a0consider non-colonoscopy based screenings if screening is\u00a0desired post age 75 (eg barium enema, CT colography, sigmoidoscopy, fecal immunochemical or DNA testing, guaiacs)<\/p>\n

–this document\u00a0also stresses\u00a0informed decision-making, noting that 30% of elderly patients near the end\u00a0of life may\u00a0lack decision-making capacity<\/p>\n

–the\u00a0USPSTF recommends colorectal screening from age 50-75. between 75-84, the balance of risk and benefits is too small to recommend screening. over age 85, risks outweigh benefits. American College of Physicians recommends screening til age 75 and\u00a0if >10 year life expectancy.\u00a0\u200b<\/p>\n

So, it is hard to make a strong recommendation overall for routine screening in the elderly (>75 yo), especially if they have comorbidities, given the higher risk of bad events and the lower risk of an adequate evaluation. And the studies suggesting significant\u00a0benefit in the 15+ year range do\u00a0support doing a final screening\u00a0colonoscopy in the early\u00a070s. One additional factor now is the insurance-driven\u00a0requirement that these procedures\u00a0be done as an outpatient (eg, I have had patients who need a diagnostic colonoscopy, are elderly and frail, and have been unable to get the insurer to cover a brief admission for the prep, even though a home-based prep would be exceedingly difficult and dangerous, putting the patient at risk for dehydration, hypotension, falls, etc).<\/p>\n","protected":false},"excerpt":{"rendered":"

By: Dr. Geoffrey Modest The medical literature has been pretty clear for the past few decades that there are significantly increased risks and decreased benefits from doing screening colonoscopy in older people. The Massachusetts Board of Registration in Medicine just published a document highlighting this point (see here).   Details: –baseline risk of colonoscopy\u00a0in general […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-669","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/669","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=669"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/669\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=669"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=669"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=669"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}