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I Sapci, K Guyton, JM Church, D Liska, E Gorgun, SR Steele, MA Valente
Cleveland Clinic Foundation

Although the risk of colorectal cancer increases with advancing age, guidelines discourage surveillance in the very elderly. Our aim was to document the yield of surveillance colonoscopies and to analyze adenoma characteristics, complications, and survival in asymptomatic octogenarian and older patients undergoing adenoma surveillance colonoscopy.

Surveillance colonoscopies performed at a tertiary level hospital colorectal surgery department between January 2010-September 2018 were queried. Patients 80 years old or older undergoing routine surveillance colonoscopy after having had an adenoma or advanced adenoma diagnosed on a prior exam were included in the study. Patients with a history of colorectal cancer, hereditary colon cancer syndromes, inflammatory bowel disease, previous negative screening colonoscopies or symptoms were excluded. Data were augmented by a review of the electronic medical record. Pearsonís chi-square test or Fisherís exact test was used for categorical factors, and ANOVA was used for continuous factors.

604 patients were included in the study with a median age of 82 (range 80-94) and 43% were female. Median follow-up after the included colonoscopy was 52 months (range 2-110 months), with 511(85%) patients alive at their last available follow-up. Four patients were diagnosed with an interval cancer at surveillance (0.6%). 105 (17.4%) patients had advanced adenomas. Overall, 292 (48%) patients had at least 1 precancerous lesion. The most common type of lesions were tubular adenomas (n=268) followed by sessile serrated lesions (n=41) and tubulovillous adenomas (n=18). Adenoma location details are listed in the Table. Increasing age was not associated with increased rate of sessile serrated lesions (p=0.2). There was an association between increasing age and advanced adenoma rates (p=0.01). Advanced adenomas were more commonly found to be right-sided (p=0.02). One patient had vasovagal reaction during colonoscopy, there were no other intra-procedural complications. 11 patients (0.01%) experienced 30-day complications: rectal bleeding, appendicitis and fall after colonoscopy. 88 patients had additional follow-up surveillance and 39 had a subsequent adenoma detected.

Patients 80 years of age or older with the previous history of colorectal adenomas have a high risk of future advanced lesions and should be considered for surveillance colonoscopy while accounting for comorbid illness and life-expectancy.

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