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Should Older Adults Be Concerned About Colonoscopy Complications?

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Key Takeaways

  • A new study shows that older adults are at a slightly higher risk of complications after having a colonoscopy.
  • An additional study found a high-quality colonoscopy is associated with over 17 years' worth of lower colorectal cancer risk.
  • Regardless of new findings, current colonoscopy and colorectal cancer screening recommendations remain in place.

Less than 4% of adults who undergo a colonoscopy experience complications, according to a new study published in JAMA Network Open in June. But that number is higher in older adults, especially those with underlying health conditions.

The study, which tracked 38,069 adults, included data from patients who had a colonoscopy in Ontario, Canada, between April 2008 and September 2017. Patients were divided into two groups: those ages 50 to 74 and those age 75 and up.

The researchers found 3.4% of all patients experienced complications within 30 days of their colonoscopy, while 6.8% of patients who were 75 and older experienced complications. Those complications included gastrointestinal tract hemorrhage, cardiovascular complications, sepsis, and bowel perforation.

There were other factors, too: Patients were more likely to have complications if they had anemia (40% more likely), high blood pressure (20% more likely), irregular heartbeat (70% more likely), or chronic kidney disease (80% more likely).

“These findings suggest that the decision to perform a colonoscopy should be carefully considered in patients older than 75 years, especially in the presence of comorbidities,” the researchers wrote.

What Is a Comorbidity?

A comorbidity refers to an additional disease or condition occurring at the same time as a primary disease or condition.

The study comes a month after research published in the Annals of Internal Medicine found that having a negative screening colonoscopy (i.e., one that didn’t find anything of concern) was linked to a lower risk of both developing colorectal cancer and death for up to 17.4 years. However, the researchers note, this was only the case with “high-quality” colonoscopies.

Why Are Colonoscopies Still Important?

A doctor may order a colonoscopy to help find the cause of symptoms like gastrointestinal bleeding, changes in bowel activity, abdominal pain, and unexplained weight loss, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). To do this, a doctor inserts a long, thin tube with a camera to look inside your rectum and colon.

Colonoscopies are also regularly used as a screening tool to detect colon polyps and cancer.

"The colonoscopy is a great procedure for colorectal cancer screening as it can prevent colorectal cancer by finding and removing premalignant polyps before they progress to colorectal cancer," Jacob Skeans, MD, a gastroenterologist at The Ohio State Wexner Medical Center, tells Verywell. "The importance of a colonoscopy is that when done with good preparation and adequate time, it can decrease one’s risk of developing colorectal cancer."

Current Recommendations For Colonoscopies

For People Age 75 and Under

The U.S. Preventive Services Task Force (USPSTF) currently recommends screening for colorectal cancer (which is often done with a colonoscopy) starting at age 50 and continuing until age 75. If you're not at an increased risk of colorectal cancer, you can expect a colonoscopy every 10 years.

Colorectal cancer is the second-leading cause of cancer deaths in the U.S. The USPSTF says it is most commonly diagnosed in adults who are 65 to 74 years old.

The American Cancer Society (ACS) has slightly different recommendations than the USPSTF. The organization says that people with an average risk of developing colon cancer should start regular screening at age 45. People who are in good health should continue screening every 10 years, the ACS says.

For People Over Age 75

Currently, the USPSTF says that doctors should consider individual patient health and screening history when deciding to screen patients older than 75. Older adults who have never been screened for colorectal cancer are most likely to benefit from screening.

The ACS also says that the decision to screen patients over the age of 75 should be based on the patient’s preferences, life expectancy, overall health, and screening history. The ACS does not recommend that people over 85 get colorectal cancer screening.

What Do the New Findings Mean for Older Adults?

It’s important to put the recent study results into perspective, colon and rectal surgeon Jeffery Nelson, MD, surgical director of Mercy's Center for Inflammatory Bowel and Colorectal Diseases, tells Verywell. While the study regarding age and colonoscopy complications does show statistical differences, he points out that “very large numbers of patients were needed to demonstrate these differences.”

Even though older people had more complications, the numbers were still low. Nelson points out there was a 0.1% mortality rate among all age groups compared to a 0.2% mortality rate among those over 75, and 0.5% vs. 1.8% incidence of cardiovascular complications.

“Physicians have to weigh that against missing colon cancers,” Nelson says. "The likelihood of dying from colorectal cancer is far higher that from colonoscopy."

The increased risk of complications in patients over 75 isn't necessarily new, but it is important for doctors to consider, Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California, tells Verywell.

However, Farhadi says that doctors should use their judgment. "There are a lot of patients that show up in my office that look like they're 60 years old, even though they're in their late 70s," he says. "It's up to us as doctors to justify if it's worth putting them through the strain of a colonoscopy. Even though the number is 75, the actual risk and benefit is totally individualized."

Can You Postpone Colonoscopies?

In regard to the study that found having a negative colonoscopy can lower your colorectal cancer risk for 17 years, Farhadi says people shouldn't start stretching out the time between colonoscopies just yet. It's possible for some polyps to be missed the first time around, giving them time more to potentially grow into a cancerous tumor if the next screening is delayed many years.

Nelson urges people to stick with current guidelines for colorectal cancer screening and colonoscopies.

“The recommendation for colonoscopy every 10 years starting at age 50 for those at average risk for colorectal cancer comes from the National Polyp Study, which was actually a series of publications starting in the 90s,” he says. “The recommendations from these studies have more or less remained unchanged since that time.”

However, Nelson says the ideal amount of time between screenings continues to be debated. The ACS lowered the recommended age to begin screening, for example, because of an increase in colorectal cancers among people in their early to mid-50s.

“We know it takes 10 to 15 years for polyps to turn into cancers, so beginning screening earlier could catch these polyps,” Nelson says.

What This Means For You

Colonoscopies are an important detection tool for colorectal cancer. While new research suggests colonoscopies can lead to an increased risk of complications in older adults, it’s best to talk to your doctor for personalized recommendations based on your individual risk and age.

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  2. Pilonis ND, Bugajski M, Wieszczy P, et al. Long-term colorectal cancer incidence and mortality after a single negative screening colonoscopy. Ann Intern Med. 2020. doi:10.7326/M19-2477

  3. Centers for Disease Control and Prevention. Colorectal cancer screening tests. Updated February 10, 2020.

  4. National Cancer Institute: Surveillance, Epidemiology, and End Results Program. Cancer stat facts: Common cancer sites. 2020.

  5. American Cancer Society. American Cancer Society guideline for colorectal cancer screening. Updated May 30, 2018.