Is anaemia a correct indication to colonoscopy in elderly patients?

Aims

Anaemia and hematochezia are common symptoms in patients (pts) aged 70 years or older. Colonoscopy is strongly recommended in these elderly pts to investigate an underlying disease. Our study evaluates role, safety and utility of colonoscopy in pts aged 70 years or older with anaemia and/or hematochezia.

Materials and methods

Were analyzed 1521 colonoscopies performed in last two years, from January 2007 to September 2008, in our Unit of Digestive Endoscopy. Two hundred ninety two pts (19.2%) had age ≥70 years. The indications, colonoscopy completion rate, endoscopic findings, complications and therapeutic consequences were evaluated. Sedation was used in all pts with midazolam (2–2.5 mg) and Floroglucine bihydrate (40–80 mg). The bowel preparation has been performed with PEG. The procedure has been accompanied by pulse oxymetry.

Results

Two hundred ninety two pts, age range 70–97 years, 176 males, underwent colonoscopy. In these 292 elderly pts anaemia or hematochezia was indication for colonoscopy in 78 cases (26.7%). The other most frequent indications were: abdominal pain (58 pts = 19.7%), diarrhoea or constipation (35 pts = 12.2%), follow-up of colonic surgery or endoscopic polypectomy (120 pts = 41%). In these 78 pts colonoscopy was completed in 72 pts (92.3%). Four pts presented a neoplastic stenosis. In two pts failure was pool bowel preparation. There weren't cardiologic or respiratory complications. The pathologic findings were: diverticular disease in 29 pts (37.2%), polyps in 16 pts (20.5%), cancer in 12 pts (15.4%), haemorroids in 9 pts (11.5%), aspecific colitis in 8 pts (10.2%), other in 4 pts (5.1%).

Conclusion

Colorectal cancer or polyps were detected in 32/78 pts (41%). Of these 26 pts (81.5%) successfully underwent a curative treatment (surgery or endoscopic polypectomy).

Furthermore our results show that 7 neoplastic lesions (22%) were located in transverse or right colon; thus we suggest carrying out a total colonoscopy for diagnosis of colonic lesions.

Colonoscopy is absolutely indicated in elderly pts with anemia; in fact over the third of examined pts (32/78) presented a neoplastic lesion.