Colonoscopy in patients 80 years of age and older is safe, with high success rate and diagnostic yield
Colonoscopy in patients 80 years of age and older is safe, with high success rate and diagnostic yield
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DOI：
10.1016/s0016-5107(04)01715-8
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发表时间：
2004-09-01
影响因子：
7.7
通讯作者：
Singh, P
中科院分区：
文献类型：
--
作者：
Arora, A;Singh, P
背景。结肠镜检查是结肠疾病的标准检查，但临床医生往往不愿意推荐老年患者进行结肠镜检查，因为他们认为结肠镜检查的风险更高，检查不完整的比例也很高。方法：前瞻性收集了31个月期间924例连续结肠镜检查的数据。将80岁及以上患者（O组）和80岁以下患者（Y组）进行比较。收集镇静、原始和调整的总结肠镜检查率、回肠镜检查率、肛门到盲肠时间、总手术时间、诊断率和并发症的数据。适当的排除以计算手术成功率和时间。结果：与Y组（n = 814）相比，O组（n = 110）患者接受的镇静药物明显少于Y组（n = 814）（咪达唑仑的中位剂量，1 mg对2.5 mg；哌替啶的中位剂量，12.5 mg对25 mg； p < 0.0001）。O组和Y组调整后的总结肠镜检查率分别为97%和99.2%（无统计学意义）。O组回肠镜检查率明显低于对照组（71.1% vs. 86.1%; p = 0.0004）。单假设检验中，O组肛门正中到盲肠的时间明显更长（9.75 vs 8.5分钟，p = 0.0182）；然而，Bonferroni校正对数据的多次检验消除了这种重要性。O组的中位总手术时间也更长（22分钟vs. 18.5分钟；p = 0.0001）。两组的诊断率高，并发症发生率低。O组结直肠癌检出率为20%，Y组为7.4% （p < 0.0001）。结论：80岁及以上患者行结肠镜检查安全、有效，诊断率高。手术时间稍长，回肠镜检查率较低。
Background. Colonoscopy is the standard investigation for colonic disease, but clinicians often are reluctant to refer elderly patients for colonoscopy because of a perception of higher risk and a high rate of incomplete examinations.Methods: Data were prospectively collected on 924 consecutive colonoscopies performed over a 31-month period. Comparisons were made between two groups: patients 80 years of age or older (Group O) and patients less than 80 years of age (Group Y). Data were collected on sedation, crude and adjusted total colonoscopy rates, ileoscopy rate, anus to cecum time, total procedure time, diagnostic yield, and complications. Appropriate exclusions were made to calculate procedure success rates and time.Results: Patients in Group O (n = 110) received significantly less sedative medication compared with Group Y (n = 814) (median dosage for midazolam, 1 mg vs. 2.5 mg; median dosage for meperidine, 12.5 vs. 25 mg; p < 0.0001). The adjusted total colonoscopy rate was 97% and 99.2% for Group O and Group Y (not significant), respectively. Ileoscopy rate was significantly lower in Group O (71.1% vs. 86.1%; p = 0.0004). Median anus to cecum time was significantly longer in Group O (9.75 vs. 8.5 minutes; p = 0.0182) in a single test of hypothesis; however, Bonferroni correction for multiple testing of data removes this significance. Median total procedure time also was longer in Group O (22 vs. 18.5 minutes; p = 0.0001). Diagnostic yield was high, and the complication rate was low for both groups. Colorectal cancer was detected in 20% patients in Group O and 7.4% in Group Y (p < 0.0001).Conclusions: Colonoscopy in patients 80 or more years of age is safe, effective, and has a high diagnostic yield. Procedure times are slightly longer, and the ileoscopy rate is lower in this age group.