Colonoscopy in Octogenarians at a United Kingdom District General Hospital: Indications, Diagnostic Yield, Completion Rates, and Procedural Tolerance

BackgroundColonoscopy remains the standard investigation of the large bowel because it permits direct mucosal visualisation, biopsy, polypectomy and ultimately tissue diagnosis.However, colonoscopy in octogenarians can be technically challenging because of multimorbidity, frailty, impaired mobility, difficulties with bowel preparation and preexisting conditions such as diverticulosis.The balance between diagnostic yield and procedural burden is, therefore, particularly important in this cohort of patients. MethodsThis was a single-centre retrospective analysis of prospectively collected data.All patients aged ≥80 years who underwent colonoscopy at Southport and Ormskirk Hospital between January and December 2021 were evaluated; three were excluded because of insufficient documentation.Patient characteristics, indications for the procedure, comorbidities, medications and procedural outcomes were obtained from electronic medical records and endoscopy databases.Procedure-related outcomes included bowel preparation quality, caecal intubation, patient comfort, sedation and analgesia, endoscopic findings and the requirement for additional diagnostic investigations. ResultsA total of 105 patients were analysed (65 men, 40 women).The most common indications were change in bowel habit (n = 37; 35.2%) and anaemia (n = 36; 34.3%), followed by rectal bleeding (n = 14; 13.3%), abnormal CT findings (n = 13; 12.4%), positive faecal occult blood test (n = 10; 9.5%) and surveillance for previous neoplasia or inflammatory bowel disease (n = 10; 9.5%).Fifty patients (47.6%) had more than three comorbidities, 61 (58.1%) were taking more than three regular medications, and 22 (21.0%) were receiving anticoagulation.Good or excellent bowel preparation was achieved in 46 (43.8%) examinations.Colonoscopy was complete (caecal, terminal ileal or anastomotic intubation) in 81 (77.1%) patients.Among the 24 incomplete examinations, documented causes were patient discomfort (n = 7; 29.2%), an obstructing or narrowing lesion (n = 6; 25.0%), looping, acute angulation or other difficult anatomy (n = 6; 25.0%), inadequate bowel preparation (n = 4; 16.7%) and diverticular disease (n = 2; 8.3%).Endoscopic findings included diverticulosis (n = 68; 64.8%), malignancy (n = 15; 14.3%), polyps (n = 14; 13.3%) and colitis (n = 4; 3.8%).Entonox (50% nitrous oxide and 50% oxygen) alone was used in 46 (43.8%) procedures, and three (2.9%) were performed without sedation or analgesia.Most patients (n = 78; 74.3%) had a comfort score of 1 or 2 on a five-point scale. ConclusionsColonoscopy remains an important diagnostic investigation in appropriately selected octogenarians and demonstrated a substantial diagnostic yield in this cohort.However, completion and bowel preparation rates were lower than contemporary quality standards.Individualised assessment of frailty, comorbidity, mobility, bowel preparation tolerance, life expectancy and patient preferences may help identify patients most likely to benefit from colonoscopy and those in whom alternative large-bowel imaging should be considered.