In a population-based, cross-sectional study published in the Journal of the American Medical Association Network Open, researchers aimed to estimate surveillance colonoscopy yields among older patients.
The primary outcomes and measures included yields of colorectal cancer (CRC), advanced adenoma, and advanced neoplasia overall (all ages) per age group and per both age group and prior adenoma finding. The researchers used multivariable logistic regression to detect factors associated with advanced neoplasia detection at surveillance.
The study cohort consisted of individuals aged 70 to 85 years and who received surveillance colonoscopies at a large, community-based U.S. healthcare system between January 1, 2017, and December 31, 2019.
The study enrolled 9,601 patients (60.5% males and 68.9% Caucasian). Of the 9,740 colonoscopies, 58.9% were performed in patients aged 70 to 74 years, 33.1% in those aged 75 to 79 years, and 8% in those aged 80 to 85 years.
All patients had an adenoma discovered within the previous 12 months or more, and the average time interval between index and surveillance colonoscopy was 4.9 years, and advanced adenomas were discovered in 23.7% of index procedures.
The results revealed that in general, researchers identified CRC during 28 procedures (0.3%), advanced adenoma in 1,141 (11.7%), and advanced neoplasia in 1,169 (12.0%) and noted that yields did not vary among age groups. The results also indicated that CRC was detected in 0.2% of those aged 70 to 74 years, 0.4% in those aged 75 to 79 years, and 0.4% of those aged 80 to 85 years, with comparable reports for advanced adenoma (11.8%, 11.3%, and 12.6%) and advanced neoplasia (12%, 11.7%, and 13%), respectively.
The authors also discovered that “Overall, CRC yields were higher for colonoscopies among patients with a prior advanced adenoma versus nonadvanced adenoma (12 of 2,305 [0.5%] vs. 16 of 7,435 [0.2%]; P = .02), and the same was observed for advanced neoplasia (380 of 2,305 [16.5%] vs. 789 of 7,435 [10.6%]; P <.001).”
The factors correlated with advanced neoplasia at surveillance were prior advanced adenoma (adjusted odds ratio [AOR], 1.65; 95% CI, 1.44-1.88), BMI of 30 kg/m2 or greater versus less than 25 kg/m2 (AOR, 1.21; 95% CI, 1.03-1.44), and history of smoking tobacco (AOR, 1.14; 95% CI, 1.01-1.30). Being of Asian or Pacific Islander ethnicity was inversely correlated with advanced neoplasia (AOR, 0.81; 95% CI, 0.67-0.99).
After reviewing the data, the authors concluded, “In this cross-sectional study of surveillance colonoscopy yield in older adults, CRC detection was rare regardless of prior adenoma finding, whereas the advanced neoplasia yield was 12.0% overall.”
The authors also noted that yields were greater among those with a prior advanced adenoma than among patients with prior nonadvanced adenoma and did not expand significantly with age.
Lastly, the authors wrote, “With current guidelines offering no specific age at which to stop surveillance colonoscopy, the study findings can inform clinicians and older patients regarding the potential benefits (or lack of benefits) of continuing with post polypectomy surveillance in the context of the life expectancy of the patient and weighed against the rare but known harms of colonoscopy, which increase with advancing age and comorbidities.”
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
