Surveillance Colonoscopy in Older Adults with Lower Life Expectancy: Are We Overutilizing?

 Surveillance Colonoscopy in Older Adults with Lower Life Expectancy: Are We Overutilizing?

What is surveillance colonoscopy?

Surveillance colonoscopy is a common practice in older adults with a history of colon polyps. However, recent research suggests that this procedure may be overutilized in individuals with lower life expectancy.

Despite the lack of clear guidance for clinicians and patients in making decisions about surveillance colonoscopy, most older adults are advised to return for future colonoscopy, regardless of their life expectancy or the clinical significance of current findings.

Audrey H. Calderwood, MD, MS, director of the Comprehensive Gastroenterology Center and associate professor at Geisel School of Medicine and the Dartmouth Institute, and her colleagues conducted a study to assess the connection between life expectancy and surveillance colonoscopy findings and subsequent recommendations in senior citizens who had a colonoscopy after a polyp had been detected from April 2009 to December 2018, 

Utilizing information from the New Hampshire Colonoscopy Registry Medicare Claims database, this database is employed for data.

Results

The results of the study, published in JAMA Internal Medicine, showed that 57.5% of the participants had an estimated life expectancy of at least 10 years, 35% had 5 to 10 years, and 7.5% had less than 5 years. Self-reported assessments of fair or poor health increased as estimated life expectancy decreased, and age was strongly correlated with estimated life expectancy.

Interestingly, while most participants had no significant findings or only small adenomas or serrated polyps, a significant proportion of them were advised to return for future colonoscopy, even without significant colonoscopy findings or limited life expectancy. This suggests that colonoscopy may be overutilized in this demographic.

Furthermore, the study found that longer life expectancy was associated with a recommendation to return for future colonoscopy regardless of clinical findings. For example, even in patients with no polyps or few small polyps, a substantial percentage of them were advised to return for future surveillance colonoscopy, especially if their life expectancy was 5 to 10 years or more.

These findings have important implications for clinical practice. Calderwood suggests that tailoring recommendations for surveillance colonoscopy based on life expectancy may be necessary. For instance, in patients with a life expectancy of less than 5 years, a recommendation against surveillance colonoscopy may be appropriate, as the potential harms may outweigh the benefits in this population.

On the other hand, if the future health status of a patient is unknown, clinicians should avoid providing definitive recommendations for future colonoscopy, allowing for flexibility in decision-making when their health status becomes clearer in the future.

Conclusion

In conclusion, surveillance colonoscopy may be overutilized in older adults with lower life expectancy, as most patients are advised to return for future colonoscopy regardless of their life expectancy or the clinical significance of current findings. Tailoring recommendations for surveillance colonoscopy based on life expectancy may be necessary to ensure that the benefits outweigh the risks in this population.