Colonoscopy in the elderly : risks versus benefits compared with younger patients

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Aims Chronic constipation remains a prevalent reason for consultation in Gastroenterology. It affects approximately 25% of the general population and may reveal an underlying organic or functional pathology. Our study aims to determine the frequency of lesions diagnosed through colonoscopy and the factors associated with pathological colonoscopy concerning age. Methods This retrospective comparative study collected data from all patients who underwent colonoscopy for exploring chronic constipation over a four-year period. Patients underwent a PEG-based bowel preparation and followed a residue-free diet. They were divided into two groups: G1, aged less than 50 years, and G2, aged over 50 years. Epidemiological, clinical, and endoscopic data were compared between the two groups using SPSS 20.0 software, with significance set at p<0.05. Results A total of 1000 colonoscopies were conducted between January 2019 and August 2023, with 308 performed for chronic constipation. The mean patient age was 49 years, ranging from 17 to 81 years, with a male-to-female ratio of 1.36 (57.8% men and 42.2% women). Group 1 comprised 66 patients (21.4%), while Group 2 had 242 patients (78.6%). Constipation was associated with subocclusive syndrome (29.9% – 15.2% vs. 33.9%), nonspecific abdominal pain (32.5% – 45.5% vs. 28.9%), abdominal bloating (42.2% – 33.3% vs. 44.6%), alternating diarrhea-constipation (16.2% – 18.2% vs. 15.7%), rectal bleeding (16.2% – 15.2% vs. 16.5%), melena (1.9% – 0% vs. 2.5%), and general health deterioration (8.4% – 12.1% vs. 7.4%). Suspicious thickening on abdominal CT scan was found in 7.1%: G1 – 3% vs. G2 – 8.2%. Inadequate preparation was noted in 15.2% (n=5) in Group G1 and 24% (n=29) in Group G2. Colonoscopy was normal in 44.2% (75.8% vs. 35.5%) and pathological in 47.4% (21.2% vs. 54.5%). Endoscopic findings included colonic polyps (23.4% – 12.1% vs. 26.4%), rectal polyps (8.4% – 0 vs. 10.7%), colonic diverticulosis (17.5% – 12.1% vs. 19%), colorectal neoplasia (9.7% – 3% vs. 11.6%), lipoma (4.5% – 0% vs. 5.8%), and angiodysplasia (1.3% – 0% vs. 1.7%). Factors associated with pathological colonoscopy for constipation were age over 50 years (p<0.001), gender (p=0.01), subocclusive syndrome (p=0.01), and general health deterioration (p=0.029). Neither rectal bleeding, anemia, abdominal pain, alternating diarrhea-constipation, nor colonic thickening on abdominal CT scan were considered risk factors for pathological colonoscopy. Conclusions Our study indicates that age over 50, male gender, subocclusive syndrome, and patient-reported general health deterioration are associated with pathological colonoscopy. Among subjects under 50 years old, 21.4% had pathological colonoscopy, with colorectal neoplasia observed in 3%. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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