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Yield and Practice Patterns of Surveillance Colonoscopy Among Older Adults

An Analysis of the GI Quality Improvement Consortium

Calderwood, Audrey H. MD, MS1,2; Holub, Jennifer L. MPH3; Greenwald, David A. MD4; Robertson, Douglas J. MD, MPH5

American Journal of Gastroenterology: November 2019 - Volume 114 - Issue 11 - p 1811–1819
doi: 10.14309/ajg.0000000000000430
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OBJECTIVES: There is little guidance regarding when to stop surveillance colonoscopy in individuals with a history of adenomas or colorectal cancer (CRC). We evaluated both yield and recommendations for follow-up colonoscopy in a large cohort of older individuals undergoing colonoscopy, using the GI Quality Improvement Consortium registry.

METHODS: We analyzed the yield of colonoscopy in adults aged ≥75 years, comparing those who had an indication of surveillance as opposed to an indication of diagnostic or screening, stratified by 5-year age groups. Our primary outcome was CRC and advanced lesions. We also evaluated recommended follow-up intervals by age and findings.

RESULTS: Between 2010 and 2017, 376,686 colonoscopies were performed by 3,976 endoscopists at 628 sites, of which 43.2% were for surveillance. Detection of CRC among surveillance patients increased with age from 0.51% (age 75–79 years) to 1.8% (age ≥ 90 years); however, these risks were lower when compared with both the diagnostic and screening for the same age band (P < 0.0001). Yield of advanced lesions also increased by every 5-year interval of age across all groups by indication. Even at the most advanced ages and in those with nonadvanced findings, only a minority of patients were recommended for no further colonoscopy. For example, in patients aged 90 years and older with only low risk findings, 62.9% were recommended to repeat colonoscopy.

DISCUSSION: Surveillance colonoscopy is frequently recommended at advanced ages even when recent findings may be clinically insignificant. Further work is needed to develop guidelines to inform best practice around when to stop surveillance in older adults.

1Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA;

2The Geisel School of Medicine at Dartmouth and the Dartmouth Institute of Health Policy and Clinical Practice, Hanover, New Hampshire, USA;

3GI Quality Improvement Consortium, Bethesda, Maryland, USA;

4Department of Medicine, Mount Sinai Hospital, New York, New York, USA;

5Department of Veterans Affairs Medical Center, White River Junction, Hartford, Vermont, USA.

Correspondence: Audrey H. Calderwood, MD, MS. E-mail: audrey.h.calderwood@hitchcock.org.

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/B299, http://links.lww.com/AJG/B300, and http://links.lww.com/AJG/B301

Received May 23, 2019

Accepted September 06, 2019

Online date: October 24, 2019

© The American College of Gastroenterology 2019. All Rights Reserved.
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