Prevalence of colonoscopy-related adverse events in older adults aged over 65 years: a systematic review and meta-analysis.

Background: This study aims to assess the occurrence of colonoscopy-related adverse events (AEs) in adults aged over 65 years, as there has been a significant increase in the prevalence of colonoscopies among the elderly compared to two decades ago.

Methods: A comprehensive search was conducted on June 3rd, 2024, using the PubMed, Embase, and Cochrane Library databases. Meta-analyses were performed using the generalized linear mixed model, and the results were presented as pooled rates with relevant 95% confidence intervals (CIs).

Results: We retrieved a total of 15,417 records and included 13 population-based studies. The overall rates of colonoscopy-related perforation and bleeding in the elderly population were 7.8 (95% CI 5.5-11.2; I2 = 94%) and 23.5 (95% CI 9.0-61.3; I2 = 100%) per 10,000 colonoscopies, respectively. The " > 80 years" group had a significantly higher risk of perforation (RR 2.55; 95% CI 1.15-5.66; I2 = 79%) and bleeding (RR 1.23; 95% CI 1.02-1.48; I2 = 0%) compared to the "65-80 years" group. For screening colonoscopies, the rates of perforation and bleeding were 8.5 (95% CI 7.1-10.2; I2 = 0%) and 27 (95%CI 9.0-81.0; I2 = 99%) per 10,000 colonoscopies, respectively. For diagnostic colonoscopies, the rates of perforation and bleeding were 18 (95% CI 16.2-20.0; I2 = 1%) and 16 (95% CI 8.1-31.3; I2 = 98%) per 10,000 colonoscopies, respectively. Compared to non-therapeutic colonoscopies, therapeutic procedures exhibited higher rates of both perforation (1.5 vs. 0.4 per 10,000 colonoscopies) and bleeding (7.1 vs. 0.5 per 10,000 colonoscopies). The prevalence of cardiopulmonary AEs in elderly population is relatively high, although the definition used vary across different studies.

Conclusions: We conducted a comprehensive analysis on the prevalence of AEs related to colonoscopy in older adults. Overall, the AEs rates remain low. However, we emphasize the importance of enhancing safety protocols to further minimize risks, ensuring that the benefits of colonoscopy continue to outweigh the risks, especially for patients over the age of 80.