Advanced age alone should not preclude surveillance colonoscopy in the octogenarian and older population

Although the risk of colorectal cancer increases with advancing age, there remains a lack of guidelines for surveillance colonoscopy in the octogenarian and older population. Our objective is to document the diagnostic yield of surveillance colonoscopies, and to analyze adenoma characteristics, complications, and short-term survival in asymptomatic octogenarian and older patients undergoing adenoma surveillance colonoscopy.

Surveillance colonoscopies performed at a tertiary level hospital colorectal surgery department between January 2010 and September 2018 were queried from a prospectively maintained institutional colonoscopy database. Patients 80 years old or older undergoing routine surveillance colonoscopy after having had an adenoma or advanced adenoma diagnosed on a prior exam were included in the study.

604 patients were included in the study with a median age of 82 and 43% were female. Median follow-up was 52 months (range 2-110), with 511(85%) patients alive at their last available follow-up. Overall, 292 patients had at least one had adenomatous lesion and 105 (17.4%) patients had advanced adenomas. Increasing age was not associated with increased rate of sessile serrated lesions (p = 0.2) however, there was an association between increasing age and advanced adenoma rates (p = 0.01). Advanced adenomas were more commonly found to be right-sided (p = 0.02). Four asymptomatic patients were diagnosed with cancer at surveillance (0.6%).

Patients 80 years of age or older with a previous history of colorectal adenoma(s) may have a high risk of future advanced lesions and can be considered to undergo surveillance colonoscopy.