Colonoscopy follow-up safe after 75: Study finds age alone shouldn’t guide decisions

Editor's Note

Routine colonoscopy surveillance after polyp removal is safe for adults over 75 and should not be ruled out based on age alone, according to a new study from Kaiser Permanente published on May 27 in Clinical Gastroenterology and Hepatology. The research, conducted as part of the National Cancer Institute-funded PROSPR consortium, fills a gap in the literature, particularly regarding outcomes for older adults following surveillance colonoscopy.

The findings challenge long-standing assumptions that older age should automatically end follow-up screening, instead advocating for shared decision-making based on individual health, prior findings, and patient preference. As detailed in the article, researchers examined data from 84,172 surveillance colonoscopies conducted between 2010 and 2019 among Kaiser Permanente Northern California members aged 45 to 85. Of the total procedures, fewer than 1% resulted in complications across all age groups, including among patients aged 76 to 85. The most common complication was gastrointestinal bleeding, reported in fewer than 0.39% of cases.

Lead author Jeffrey K Lee, MD, MPH, emphasized to the outlet that while the risk of complications does rise with age, the study’s low complication rate among older adults supports a more nuanced approach. Currently, guidelines recommend continued surveillance colonoscopies for individuals with a history of precancerous polyps, given their elevated risk for colorectal cancer. However, the article notes that formal guidance is lacking for surveillance decisions in patients over 75—the age at which routine colorectal cancer screening is typically discontinued.

The outlet reports that across all age groups, patients on blood thinners, those with multiple comorbidities, or those with prior advanced polyp findings were at greater risk for complications. Still, the study's findings reinforce that advanced age alone should not serve as a categorical exclusion from surveillance colonoscopy.