Colonoscopies Often Unnecessary, Harmful for Elderly Patients: Study

Elderly patients who undergo colonoscopies are unlikely to choose treatment if colorectal cancer cells are detected, say researchers.

Doctors often recommend colonoscopy exams to screen for colorectal cancer among senior patients, even though research suggests that the procedures are often unnecessary, and may be harmful for individuals over the age of 75.

In a new study recently published in the Journal of the American Medical Association (JAMA), researchers with the Cleveland Clinic warn that conducting a colonoscopy on patients with a life expectancies under 10 years may significantly increase the risk of life threatening complications.

Researchers indicate that many older patients decline treatment if cancer cells are detected during the exams, making the colonoscopy risks unnecessary.

The study aligns with prior research that has found senior patients often do not benefit from invasive screening tools like colonoscopies, which require insertion of a tube mounted video camera into a sedated patient’s rectum to examine the colon and large intestine for signs of cancer.

As an individual gets older, the risk of colonoscopy complications increase, including the potential for bowel perforation, bleeding, incontinence and misdiagnosed cancer from false positive results.

Data indicates many doctors know that invasive screening tests and treatments are unnecessary and even harmful for some patients, but continue to recommend them as standard care.

Colonoscopy Complications

In this new study, researchers evaluated data on 7,067 patients older than 75, who were undergoing outpatient colonoscopies at clinics in Ohio and Florida between January 2009 and January 2022. Of the patients evaluated, 82% were between 76-80 years old, 14% were between 81-85 years old, and 4% were 86 years or older.

The researchers found that adverse events from severe colonoscopy complications increased significantly with each increase in age range. Out of 1,000 patients aged 76-80, 2.42 experienced at least one adverse event such as bowel perforation, gastrointestinal distress, or hospitalization. Of the 81-85 age group, 3.92 patients out of 1,000 suffered at least one complication. The 86 and up age group had the highest rate of adverse events, with 11.07 patients out of 1000 experiencing an adverse event, a rate exceeding standard quality measures.

Overall, the risk of colonoscopy complications that resulted in hospitalization was 13.58 per 1,000 patients older than 75 undergoing colonoscopies, the researchers determined.

Additionally, while colorectal cancer cells were detected in 15 of the patients analyzed, only five elected to pursue treatment.

The researchers noted that while the U.S. Preventative Services Task Force recommends against colonoscopy screening for those over age 85, the task force “does not stipulate how the practice might be implemented.”