Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association | 2021
Yield and Predictors of surveillance colonoscopies in older adults with long-standing ulcerative colitis.
Abstract
BACKGROUND\nWhile colonoscopies for dysplasia surveillance are standard of care in patients with long-standing ulcerative colitis (UC), there is a paucity of data on the yield of surveillance colonoscopies in those older than age 75 years.\n\n\nMETHODS\nWe conducted a multicenter retrospective cohort study including patients with UC who underwent ≥1 colonoscopy at age >75 years. The primary outcome was diagnosis of dysplasia (visible or random) and colorectal cancer (CRC). Multivariable regression adjusted for relevant confounders examined the predictors of polypoid or non-polypoid dysplasia or CRC.\n\n\nRESULTS\nThe primary cohort included 211 patients with UC who underwent 635 colonoscopies after age > 75 years. A total of 83 patients (39.3%) patients had dysplasia or cancer detected. Among colonoscopies, 123 (19.4%) identified visible dysplasia, 23 (3.6%) had random dysplasia (1 high grade dysplasia found in each group respectively), and 5 (0.8%) had colon cancer. In multivariable analysis, prior adenoma or colon cancer below age 75 (odds ratio [OR] 2.06; 95%CI, 1.07-3.96), flat dysplasia before 75 years (OR 2.78; 95%CI 1.05-7.44), and older age (80-84 years (OR 2.29, 95%CI 1.20-4.38), ≥85 years (OR 3.54, 95%CI 1.27-9.82) were associated with detection of dysplasia or cancer. Only 1 patient was noted to have a procedure-related complication.\n\n\nCONCLUSIONS\nPatients with long-standing UC without prior dysplasia may have a low yield on continued endoscopic surveillance at age > 75 years. A targeted approach to surveillance may be appropriate in older individuals with UC.