March 21, 2023 – More often than not, when a polyp is discovered throughout an older grownup’s colonoscopy, it’s unlikely {that a} regarding polyp or colon most cancers shall be discovered throughout a future surveillance scan. But most sufferers are suggested to repeat the colonoscopy even when they aren’t anticipated to stay very lengthy, a brand new examine has discovered. 

“Given the shortage of clear steerage about when to cease colonoscopy in older sufferers, I’m not stunned that physicians suggest surveillance even in sufferers with low life expectancy,” mentioned Ziad Gellad, MD, MPH, with Duke College Medical Middle in Durham, NC, who was not concerned within the analysis.

“These are nuanced selections that require shared determination making. It’s not simple to inform sufferers that they’re too previous to get preventive care, particularly sufferers in whom your solely interplay is the process itself,” Gellad mentioned. 

Present pointers suggest docs and sufferers make selections about repeat colonoscopy in older adults with prior polyps, weighing the potential advantages (figuring out and eradicating significant polyps to forestall most cancers) towards the burdens and potential harms, similar to bleeding.

Whereas most colon polyps should not dangerous, a subset of polyps, if allowed to develop, have the potential to grow to be most cancers, a change that may take 10 to fifteen years. This lengthy timeline highlights the significance of contemplating life expectancy in deciding which sufferers ought to have a repeat colonoscopy.

The brand new examine concerned practically 10,000 adults age 65 and older present process surveillance colonoscopy resulting from a previous polyp. Fewer than 1 in 10 of those people have been discovered to have superior polyps or colorectal most cancers throughout a repeat colonoscopy. 

But the overwhelming majority (87%) of people whose physician gave a suggestion to cease or proceed colonoscopy have been suggested to return for one more process sooner or later – even after they had no important colonoscopy findings or restricted life expectancy, together with lower than 5 years. 

In some circumstances, the advisable time to repeat colonoscopy was higher than the person’s life expectancy.

Problems throughout colonoscopies occur to about 26 in each 1,000 individuals — practically 10 instances higher than the potential advantages as seen of their examine by way of figuring out most cancers.

These findings “might assist refine decision-making” in regards to the potential advantages and harms of pursuing or stopping surveillance colonoscopy in older adults with a historical past of polyps, write the investigators, led by Audrey Calderwood, MD, with Dartmouth Hitchcock Medical Middle in Lebanon, NH. 

Based mostly on their findings, they assume older adults anticipated to stay fewer than 5 extra years ought to skip surveillance colonoscopy.  The identical goes for people whose life expectancy is between 5 and fewer than 10 years they usually solely have “low threat” polyps.

For the wholesome senior with a life expectancy of 10 or extra years and up to date “superior” polyps, they recommend the physician present a suggestion for future surveillance colonoscopy with a caveat that the final word determination depends on well being and priorities on the time the colonoscopy is due.



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