NEW YORK (Reuters Health) – People over 75 years who undergo colonoscopy or flexible sigmoidoscopy are six times more likely to experience a colon perforation than younger individuals, according to findings from Thailand.
Performance of a therapeutic intervention during endoscopy also seems to increase the risk of perforation, according to the report in the September 24th issue of BMC Gastroenterology. Still, the absolute risk of perforation was small: just 0.15%.
Lead researcher Dr. Varut Lohsiriwat, from Mahidol University in Bangkok, told Reuters Health that the association of perforation with advanced age was unexpected. He speculated that the “elderly might have a weaker strength of the bowel wall or be subjected to more endoscopic interventions.”
Dr. Lohsiriwat and colleagues analyzed data on all 8987 colonoscopies and 1137 flexible sigmoidoscopies performed at their hospital between January 2005 and July 2008. Fifteen colon perforations occurred (0.15%).
Colonoscopy was linked to a 77% higher risk of perforation than was flexible sigmoidoscopy, but the association was not statistically significant. Patient gender, emergency status, anesthetic method, and endoscopist specialty or experience were not significant predictors of perforation.
On multivariate analysis, patient age over 75 years and therapeutic endoscopy were the only independent predictors of colon perforation, increasing the risk by 6.24- and 2.98-fold, respectively (p < 0.001 and p = 0.036).
“Extra care must be taken while performing colonoscopy in older patients as well as doing endoscopic interventions,” Dr. Lohsiriwat emphasized. “Non-invasive investigation of the colon such as CT colonography, if applicable, might be considered in such advanced age patients.”
Reference:
BMC Gastroenterology 2009;9:71.
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