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Inicio Gastroenterología y Hepatología (English Edition) Risks, indications and technical aspects of colonoscopy in elderly or frail pati...
Journal Information
Vol. 47. Issue 1.
Pages 107-117 (January 2024)
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Vol. 47. Issue 1.
Pages 107-117 (January 2024)
Clinical practice guidelines
Risks, indications and technical aspects of colonoscopy in elderly or frail patients. Position paper of the Societat Catalana de Digestologia, the Societat Catalana de Geriatria i Gerontologia and the Societat Catalana de Medicina de Familia i Comunitaria
Riesgos, indicaciones y aspectos técnicos de la colonoscopia en pacientes de edad avanzada o con fragilidad. Documento de posicionamiento de la Societat Catalana de Digestologia, la Societat Catalana de Geriatria i Gerontologia i la Societat Catalana de Medicina de Familia i Comunitaria
Salvador Machlaba,b, Esther Franciac, Juanjo Mascortd,e, Pilar García-Iglesiasa, Juan Manuel Mendivef, Francesc Ribag, Carles Guarner-Argenteh,i, Mònica Solanesj, Jordi Ortizk, Xavier Calveta,b,i,
Corresponding author
xcalvet@tauli.cat

Corresponding author.
a Servei d’Aparell Digestiu, Parc Taulí, Hospital Universitari, Institut de Recerca Parc Taulí, Sabadell, Spain
b Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
c Servei de Medicina Interna, Unitat de Geriatria, Hospital de Sant Pau, Barcelona, Spain
d CAP Florida Sud, Institut Català de La Salut, Hospitalet de Llobregat, Spain
e Departament de Ciències Clíniques, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
f CAP La Mina, Institut Català de La Salut, Sant Adrià de Besòs, Spain
g Servei de Geriatria i Cures Pal·liatives, Hospital de la Santa Creu Jesús, Tortosa, Spain
h Servei Aparell Digestiu, Hospital de Sant Pau, Barcelona, Spain
i CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
j CAP Onze de Setembre, Institut Català de la Salut, Lleida, Spain
k Servei d’Aparell Digestiu, Consorci Sanitari de Terrassa, Terrassa, Spain
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Tables (3)
Table 1. Main conclusions and recommendations.
Table 2. Risk of complications per 1000 endoscopies based on the meta-analysis by Day et al.2
Table 3. Organic diarrhoea/warning signs criteria.
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Abstract

Colonoscopy (CS) is an invasive diagnostic and therapeutic technique, allowing the study of the colon. It is a safe and well tolerated procedure. However, CS is associated with an increased risk of adverse events, insufficient preparation and incomplete examinations in the elderly or frail patient (PEA/F). The objective of this position paper was to develop a set of recommendations on risk assessment, indications and special care required for CS in the PEA/F. It was drafted by a group of experts appointed by the SCD, SCGiG and CAMFiC that agreed on eight statements and recommendations, between them to recommend against performing CS in patients with advanced frailty, to indicate CS only if the benefits clearly outweigh the risks in moderate frailty and to avoid repeating CS in patients with a previous normal procedure. We also recommended against performing screening CS in patients with moderate or advanced frailty.

Keywords:
Colonoscopy
Elderly
Frail patient
Resumen

La colonoscopia (CS) es una técnica invasiva, fundamental para el estudio del colon. Es un procedimiento seguro y bien tolerado. Sin embargo, en personas de edad avanzada o con fragilidad (PEA/F) aumenta el riesgo de acontecimientos adversos, preparación insuficiente o exploraciones incompletas. El objetivo de este documento de posicionamiento fue consensuar recomendaciones sobre valoración del riesgo, indicaciones y cuidados especiales necesarios para la CS en PEA/F. El documento fue redactado por un grupo de expertos designados por la SCD, la SCGiG y la CAMFiC entre 2020 y 2022. Se consensuaron 8 afirmaciones y recomendaciones, entre ellas: no realizar CS a los pacientes con fragilidad avanzada, indicar CS solo si los beneficios son claramente superiores a los riesgos en fragilidad moderada, no repetir CS en PEA/F que tienen una CS completa previa sin lesiones y no indicar CS de cribado en pacientes con fragilidad moderada o avanzada.

Palabras clave:
Colonoscopia
Edad avanzada
Paciente con fragilidad

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