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    Friday, January 15, 2010


    Despite low overall adverse event risk with colonoscopy, every age group 70 and older is at elevated risk of adverse gastrointestinal and cardiovascular events from the procedure, reports Joan L. Warren, Ph.D., of the National Cancer Institute in Bethesda, Md.. The risk of intestinal bleeding or perforation is 75% higher at age 80 to 84 than at age 66 to 69.These findings, from the Medicare claims database, support the controversial upper age limit for screening colonoscopy set by the U.S. Preventive Services Task Force.
    Because competing causes of mortality often outweigh the potential benefit from detecting colon cancer at progressively older ages, guidelines do not recommend screening past age 75 and recommend against it after 85 The reason for the increased complication risk in older persons and those with these conditions may be related to the preparation, sedation, or the procedure itself, the researchers noted.
    Certain preparations, such as sodium phosphate, can increase the likelihood of electrolyte imbalances, especially in elderly persons. In addition, persons taking ACE inhibitors, angiotensin-receptor blockers, diuretics, and nonsteroidal anti-inflammatory drugs -- all of which are commonly used in elderly persons -- may have more adverse events related to the bowel preparation for colonoscopy speculates Dr.Warren.
    Indeed Warren cautions, that the use of administrative claims data to determine complication risks -- rather than medical record review -- might underestimate the true risk of adverse events.
    Source reference:
    Warren JL, et al "Adverse events after outpatient colonoscopy in the Medicare population" ANN INTERN MED 2009; 150: 849-57.

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