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. 1992 May;68(799):355–358. doi: 10.1136/pgmj.68.799.355

Colonoscopy in patients aged 80 years or older and its contribution to the evaluation of rectal bleeding.

L Bat 1, A Pines 1, E Shemesh 1, Y Levo 1, D Zeeli 1, E Scapa 1, Y Rosenblum 1
PMCID: PMC2399402  PMID: 1630980

Abstract

Colonoscopies performed in patients aged 80 years or older at the Sheba Medical Center were analysed according to the primary indication for the procedure: 101 colonoscopies were performed because of rectal bleeding of at least 2 months duration, and 335 for all other indications. Carcinoma of the large bowel was found in 29 (28.7%) bleeders, with the rectum being the most frequently involved site (12 patients). Among the non-bleeders, the prevalence of cancer was significantly lower (33 cases, 9.8%; P less than 0.001), and rectal carcinoma was less common (five patients, P = 0.04), but proximal tumours were more frequent. Of patients with cancer who had operations, the majority (72%) had a tumour confined to the bowel wall (Dukes A or B). The rate of adenomas was similar for both groups (34% vs 29%). The non-bleeders complained more frequently of abdominal pain or a change in bowel habits as compared to the bleeders, but both groups had similar rates for anaemia and weight loss. In all, 47% of these octogenarians with cancer, and 26% with adenomas were referred for colonoscopy because of rectal bleeding. This procedure was found to be safe in old age, as we recorded only four (0.9%) non-fatal complications among our series, a similar figure to the overall incidence of complications at our Institute. In conclusion, our data indicate that rectal bleeding in octogenarians warrants a complete colonic investigation, preferably by total colonoscopy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bat L., Pines A., Rabau M., Niv Y., Shemesh E. Colonoscopic findings in patients with hemorrhoids, rectal bleeding and normal rectoscopy. Isr J Med Sci. 1985 Feb;21(2):139–141. [PubMed] [Google Scholar]
  2. Bowers F. J., Hardy T. G., Jr, Aguilar P. S., Hartmann R. F., Stewart W. R. The efficacy of barium-enema examinations in patients with anorectal disease. Dis Colon Rectum. 1987 Apr;30(4):285–287. doi: 10.1007/BF02556175. [DOI] [PubMed] [Google Scholar]
  3. Chapuis P. H., Goulston K. J., Dent O. F., Tait A. D. Predictive value of rectal bleeding in screening for rectal and sigmoid polyps. Br Med J (Clin Res Ed) 1985 May 25;290(6481):1546–1548. doi: 10.1136/bmj.290.6481.1546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. DiPrima R. E., Barkin J. S., Blinder M., Goldberg R. I., Phillips R. S. Age as a risk factor in colonoscopy: fact versus fiction. Am J Gastroenterol. 1988 Feb;83(2):123–125. [PubMed] [Google Scholar]
  5. Forde K. A., Waye J. D. Controversies, dilemmas and dialogues. Is there a need to perform full colonoscopy in a middle-age person with episodic bright red blood per rectum and internal hemorrhoids? Am J Gastroenterol. 1989 Oct;84(10):1227–1228. [PubMed] [Google Scholar]
  6. Ghazi A., Grossman M. Complications of colonoscopy and polypectomy. Surg Clin North Am. 1982 Oct;62(5):889–896. doi: 10.1016/s0039-6109(16)42839-2. [DOI] [PubMed] [Google Scholar]
  7. Glick S. N., Teplick S. K., Balfe D. M., Levine M. S., Gasparaitis A. E., Maglinte D. D., Shortsleeve M. J., Brandon J. C. Large colonic neoplasms missed by endoscopy. AJR Am J Roentgenol. 1989 Mar;152(3):513–517. doi: 10.2214/ajr.152.3.513. [DOI] [PubMed] [Google Scholar]
  8. Gooszen H. G. The relationship between carcinoma of the rectum and hemorrhoids. Arch Chir Neerl. 1978;30(4):223–229. [PubMed] [Google Scholar]
  9. Goulston K. J., Cook I., Dent O. F. How important is rectal bleeding in the diagnosis of bowel cancer and polyps? Lancet. 1986 Aug 2;2(8501):261–265. doi: 10.1016/s0140-6736(86)92081-7. [DOI] [PubMed] [Google Scholar]
  10. Guillem J. G., Forde K. A., Treat M. R., Neugut A. I., Bodian C. A. The impact of colonoscopy on the early detection of colonic neoplasms in patients with rectal bleeding. Ann Surg. 1987 Nov;206(5):606–611. doi: 10.1097/00000658-198711000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Holly E. A., Whittemore A. S., Aston D. A., Ahn D. K., Nickoloff B. J., Kristiansen J. J. Anal cancer incidence: genital warts, anal fissure or fistula, hemorrhoids, and smoking. J Natl Cancer Inst. 1989 Nov 15;81(22):1726–1731. doi: 10.1093/jnci/81.22.1726. [DOI] [PubMed] [Google Scholar]
  12. Irvine E. J., O'Connor J., Frost R. A., Shorvon P., Somers S., Stevenson G. W., Hunt R. H. Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding. Gut. 1988 Sep;29(9):1188–1193. doi: 10.1136/gut.29.9.1188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Macrae F. A., Tan K. G., Williams C. B. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut. 1983 May;24(5):376–383. doi: 10.1136/gut.24.5.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Raftery T. L., Samson N. Carcinoma of the colon: a clinical correlation between presenting symptoms and survival. Am Surg. 1980 Nov;46(11):600–606. [PubMed] [Google Scholar]
  15. Shinya H., Cwern M., Wolf G. Colonoscopic diagnosis and management of rectal bleeding. Surg Clin North Am. 1982 Oct;62(5):897–903. doi: 10.1016/s0039-6109(16)42840-9. [DOI] [PubMed] [Google Scholar]
  16. Staniland J. R., Ditchburn J., de Dombal F. T. Clinical presentation of diseases of the large bowel. A detailed study of 642 patients. Gastroenterology. 1976 Jan;70(1):22–28. [PubMed] [Google Scholar]
  17. Swarbrick E. T., Fevre D. I., Hunt R. H., Thomas B. M., Williams C. B. Colonoscopy for unexplained rectal bleeding. Br Med J. 1978 Dec 16;2(6153):1685–1687. doi: 10.1136/bmj.2.6153.1685. [DOI] [PMC free article] [PubMed] [Google Scholar]

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