Modifications in endoscopic practice for the elderly

Dayna S. Early, Ruben D. Acosta, Vinay Chandrasekhara, Krishnavel V. Chathadi, G. Anton Decker, John A. Evans, Robert D. Fanelli, Deborah A. Fisher, Kimberly Q. Foley, Lisa Fonkalsrud, Joo Ha Hwang, Terry Jue, Mouen A. Khashab, Jenifer R. Lightdale, V. Raman Muthusamy, Shabana F. Pasha, John R. Saltzman, Ravi Sharaf, Amandep K. Shergill, Brooks D. Cash

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

We recommend that with optimal periprocedure evaluation and care, diagnostic and therapeutic endoscopic interventions can be safely performed in elderly patients. We recommend that electrolyte-balanced polyethylene glycol-based colonoscopy preparations be used in elderly individuals to avoid potentially harmful fluid and electrolyte shifts. We suggest using split-dosage cathartic bowel preparations in the elderly for colonoscopy preparation. We recommend evaluating the patient's baseline functional status, cognitive ability, and capacity to understand the anticipated endoscopic procedure as part of the preprocedure assessment in the elderly. We recommend standard monitoring procedures in the elderly during moderate sedation with heightened awareness of this population's increased response to sedatives. We recommend that lower initial doses of sedatives than standard adult dosing should be considered in the elderly and that titration should be more gradual to allow assessment of the full dose effect at each dose level. We suggest that practitioners exercise additional caution when performing colonoscopy in elderly patients because this procedure may confer a higher risk of adverse events. We recommend that colonoscopic screening and surveillance for colorectal cancer in patients of advanced age be individualized based on general health and comorbid medical illnesses.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalGastrointestinal endoscopy
Volume78
Issue number1
DOIs
StatePublished - Jul 1 2013

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Keywords

  • DBE
  • OR
  • double-balloon endoscopy
  • odds ratio

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Early, D. S., Acosta, R. D., Chandrasekhara, V., Chathadi, K. V., Decker, G. A., Evans, J. A., Fanelli, R. D., Fisher, D. A., Foley, K. Q., Fonkalsrud, L., Hwang, J. H., Jue, T., Khashab, M. A., Lightdale, J. R., Muthusamy, V. R., Pasha, S. F., Saltzman, J. R., Sharaf, R., Shergill, A. K., & Cash, B. D. (2013). Modifications in endoscopic practice for the elderly. Gastrointestinal endoscopy, 78(1), 1-7. https://doi.org/10.1016/j.gie.2013.04.161