Evaluation of colonoscopy indications and the association with malignancy in patients aged 75 and over

INTRODUCTION: Colonoscopy is the gold standard for early diagnosis of colorectal cancer. Screening programs are recommended for individuals between the ages of 45-75. In this study, we aimed to evaluate the relationship between indications for colonoscopy and malignancy in patients aged 75 and above.
METHODS: Between 2021 and 2023, 12,416 colonoscopic procedures performed in our endoscopy unit were retrospectively analyzed. Of these, 946 were patients aged 75 and over. After excluding those with inaccessible data, incomplete colonoscopies, or a history of colorectal cancer/polyps, 398 were included in the study. Symptoms were categorized as follows: macroscopic bleeding, anemia, changes in bowel habits, suspicion of malignancy, weight loss, and non-specific symptoms. Rates of malignancy were subsequently determined.
RESULTS: The median age of all patients was 77 years (minimum: 75, maximum: 97), with 51.3% being male. Macroscopic bleeding was the most common symptom at 29.9%, followed by changes in bowel habits (28.6%), anemia (25.1%), non-specific symptoms (7.8%), suspicion of malignancy (6.5%), and weight loss (3.3%). Malignancy was detected in 10.8% of patients, with 55.8% of those diagnosed being female. The most prevalent symptom among these patients was macroscopic bleeding (44.2%), then anemia (25.6%), bowel habit changes (2%), suspicion of malignancy (14%), non-specific symptoms (4.7%), and weight loss (2.3%). Macroscopic bleeding (p=0.030) and suspicion of malignancy (p=0.037) were statistically significant in predicting malignancy, whereas the other symptoms were not.
DISCUSSION AND CONCLUSION: Colonoscopy can be safely performed in patients aged 75 and over. It is particularly critical for patients presenting with macroscopic bleeding and suspicion of malignancy. However, the utility of colonoscopy for other symptoms warrants further evaluation.