Outcomes and safety of colonoscopy in elderly patients aged 80 years and older: a retrospective cohort study.

Background: The incidence of colorectal tumors increases with age. Colonoscopy is crucial for early detection, yet performing it on patients aged 80 and older poses challenges due to their complex health conditions. Methods: This retrospective study included 447 elderly patients aged 80 years and older who underwent colorectal examinations at Peking University International Hospital from November 2015 to June 2024. Data on demographics, comorbidities, smoking and drinking history, and colonoscopy indications were collected. Risk factors for non-colorectal malignant tumors, colorectal malignant tumors, and colorectal advanced-stage tumors were compared. All patients received standard bowel preparation, and procedures were conducted by experienced endoscopists. Results: A total of 364 patients (81.4%) completed the procedure successfully. The main reasons for failure were inadequate intestinal preparation and intestinal stenosis. A total of 37 (8.3%) had no significant abnormalities, 315 (70.5%) were diagnosed with colorectal polyps, and 110 (24.6%) had malignant tumors. The complication rate was 0.67%. Univariate analysis showed that patients with colorectal malignant tumors were older (P = 0.000) and had a higher prevalence of alcohol consumption history (P = 0.014). For advanced tumors, patients were also older (P = 0.000). Discussion: Age is a significant risk factor for colorectal malignancies and advanced tumors. Although colonoscopy in elderly patients has acceptable safety, they face challenges in bowel preparation and examination techniques. The incidence of polyps and malignant tumors in this population is high. However, the study has limitations, such as its retrospective nature and reliance on incomplete electronic medical records. Conclusion: Colonoscopy is effective and safe for elderly patients aged 80 and older. It is essential for detecting colorectal malignancies and polyps. Age-related risk factors highlight the importance of this procedure in this high-risk group.