The indication of colonoscopy in nonagenarian patients remains controversial due to advanced comorbidity, functional impairment, and concerns regarding procedural safety and clinical benefit. We conducted a retrospective longitudinal observational study evaluating the clinical and therapeutic impact of colonoscopy in patients aged ≥90 years, with follow-up of management decisions for up to six months. Although the therapeutic yield was modest, colonoscopy influenced clinical management in nearly half of cases and led to heterogeneous and clinically relevant decisions, including extension of diagnostic workup, endoscopic therapy, referral for oncological or palliative treatment, and surgery. Overall complications occurred in 2.3% of procedures, with two cases of procedure-related mortality. Six-month mortality unrelated to the procedure was mainly attributable to comorbidities and advanced age. These findings suggest that, in carefully selected nonagenarians, colonoscopy may provide clinically meaningful information that supports individualized clinical decision-making beyond therapeutic intervention alone. Systematic assessment of frailty may further improve patient selection and risk stratification in this growing population.
Hernández et al. (Thu,) studied this question.