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Yield of Surveillance Colonoscopy in Older Adults with a History of Polyps: A Systematic Review and Meta-Analysis

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Abstract

Background

The benefit of surveillance colonoscopy in older adults is not well described.

Aims

To quantify the detection of colorectal cancer (CRC) and advanced polyps during surveillance colonoscopy in older adults with a history of colon polyps.

Methods

We conducted a systematic review (MEDLINE, Cochrane Library, Web of Science, and Embase) for all published studies through May 2020 in adults age > 70 undergoing surveillance colonoscopy. The main outcome was CRC and advanced polyps detection. We performed meta-analysis to pool results by age (>70 vs. 50–70).

Results

The search identified 6239 studies, of which 569 underwent full-text review and 64 data abstraction, of which 19 were included. The risk of detecting CRC (N = 11) was higher in those >70 compared to 50–70 (risk ratio 1.5 (95% CI 1.1–2.2); risk difference 0.8% (95% CI −0.2%–1.8%)). Similarly, the risk of detecting advanced polyps (N = 8) was higher in those >70 compared to 50–70 (risk ratio 1.3 (95% CI 1.2–1.3), risk difference 2.7% (95% CI 1.3%–4.0%)). Most studies did not stratify results by baseline polyp risk.

Conclusions

The detection of CRC and advanced polyps during surveillance colonoscopy in older individuals was higher than in younger controls; however, the absolute risk increase for both was small. These differences must be weighed against competing medical problems and limited life expectancy in older adults when making decisions about surveillance colonoscopy. More primary data on the risks of CRC and advanced polyps accounting for number of past colonoscopies, prior polyp risk, and duration of time since last polyp are needed.

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Acknowledgments

We would like to thank Dr. Douglas Robertson who served as a subject matter expert and reviewed our list of included studies to evaluate for completeness and potentially missing studies.

Funding

Dr. Calderwood is supported by 1R21CA227776-01A1, The Dartmouth-Hitchcock Cancer Research Fellows Program, and by the NCI Cancer Center Support Grant 5P30CA023108 to the Dartmouth-Hitchcock Norris Cotton Cancer Center as well as The Dartmouth Clinical and Translational Science Institute, under award number UL1TR001086 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The funding agencies played no role in the design, conduct, or interpretation of this study.

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Author notes

  1. Gregory J. Williams and Sage T. Hellerstedt have contributed equally to this work.

Authors and Affiliations

  1. The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, NH, USA

    Gregory J. Williams, Sage T. Hellerstedt & Audrey H. Calderwood

  2. Dartmouth Biomedical Libraries, Dartmouth College, Hanover, NH, USA

    Paige N. Scudder

  3. Geisel School of Medicine At Dartmouth, Hanover, NH, USA

    Audrey H. Calderwood

  4. Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA

    Audrey H. Calderwood

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  1. Gregory J. Williams
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  2. Sage T. Hellerstedt
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  4. Audrey H. Calderwood
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Contributions

STH, GJW, AHC took part in conception and design of the study; STH, GJW, PNS involved in acquisition of data; STH, GJW, AHC participated in analysis and interpretation of data; STH and GJW participated in statistical analysis; STH and GJW participated in drafting of the manuscript; STH, GJW, PNS, AHC involved in critical revision of the manuscript; AHC contributed to study supervision; STH, GJW, PNS, AHC involved in approval of the final version of the manuscript.

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Correspondence to Audrey H. Calderwood.

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Williams, G.J., Hellerstedt, S.T., Scudder, P.N. et al. Yield of Surveillance Colonoscopy in Older Adults with a History of Polyps: A Systematic Review and Meta-Analysis. Dig Dis Sci 67, 4059–4069 (2022). https://doi.org/10.1007/s10620-021-07198-6

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