Is capsule endoscopy appropriate for elderly patients? The influence of ageing on findings and diagnostic yield: An Italian retrospective study

doi:10.1016/j.dld.2015.09.004

Digestive and Liver Disease

Volume 47, Issue 12, December 2015, Pages 1086-1088

https://doi.org/10.1016/j.dld.2015.09.004 Get rights and content

Abstract

Background

Few data are available on the use of capsule endoscopy in the elderly.

Methods

We performed a retrospective study on 1008 consecutive patients referred to our centre between December 1, 2002 and January 30, 2014 who underwent capsule endoscopy for various indications. Patients were enrolled and divided into 3 sub-groups according to their age (Group A: <50 years; Group B: 50–69 years; Group C: >70 years). The Pillcam diagnostic yield, clinically significant findings and post-treatment outcomes were compared between groups.

Results

Diagnostic yield was significantly higher in Group C vs. Groups A and B (65.2% vs. 42.3% and 47.5%, respectively; p < 0.05). The most common diagnosis in the elderly was angiodysplasia (42.5%). In 84.5% of elderly patients (Group C) capsule endoscopy results modified patient management.

Conclusions

Capsule endoscopy has a high diagnostic yield and positive impact on management in patients aged >70 years.

Introduction

Capsule endoscopy (CE) is an effective diagnostic tool for small bowel disease [1], [2], [3]. Worldwide the population aged over 65 years increased from 5.2% in 1950 to 6.9% in 2000 [4], [5], [6]. Although there has been an increasing use of CE for the evaluation of small bowel disease in elderly patients [7], [8], [9], [10], [11], there are few comparative studies investigating diagnostic yield, safety and outcomes of CE in elderly compared to younger patients [12], [13], [14], [15], [16], [17]. The primary aim of our study was to investigate the differences between findings and diagnostic yield of CE in elderly patients (aged ≥70 years) compared to younger subjects; we also aimed to confirm the appropriateness of CE indication and benefit on patient management in older subjects.

Section snippets

Patients and methods

We performed a retrospective study involving consecutive patients referred for CE to the Digestive Endoscopy Unit of a tertiary care centre between December 1, 2002 and January 30, 2014; indications for the exam included occult gastrointestinal bleeding (OGIB), suspected or known Crohn's disease, malabsorption syndrome, polyposis, suspected neoplasms [17]. Exclusion criteria were intestinal obstructions, pregnancy, neurological diseases, or treatments affecting gastrointestinal motility.

Overall

Results

A total of 1008 patients were retrospectively enrolled. The cecum was reached in all cases. No case of adverse events was observed. The characteristics of the study population are shown in Table 1. Patients were divided into three groups according to their age: <50 years (group A; n = 368), 50–69 years (group B; n = 332) and >70 years (group C; n = 308). Primary indication for CE was significantly different between the 3 age groups, with OGIB being more common in group C (Table 1).

There was no

Discussion

There is little data in the published literature on the use of CE in the elderly (Supplementary Table S1). The most common indication remains OGIB, which, was confirmed as the most frequent indication for CE in the present study.

Carey et al. reported an overall yield of 53% and demonstrated that old age was associated with increased CE yield [19]. Papadopoulos et al. investigated 120 consecutive outpatients and concluded that ageing did not affect the completion rate and that elderly people had

Conflict of interest

None declared.

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Guidelines for Continuing Medical Education - Anemia in the elderly
2023, FMC Formacion Medica Continuada en Atencion Primaria
Gastrointestinal endoscopy in patients of advanced age
2018, Revista Espanola de Geriatria y Gerontologia
El incremento acelerado de la esperanza de vida en nuestro medio está conduciendo a un aumento importante del uso de endoscopia digestiva en pacientes de edad avanzada. Teniendo en cuenta estos cambios demográficos, el abordaje de la endoscopia gastrointestinal en pacientes de edad avanzada cobra gran importancia. Si bien la endoscopia gastrointestinal es en general segura y bien tolerada incluso en pacientes muy ancianos, la aparición de cambios fisiológicos asociados al envejecimiento y la mayor prevalencia de comorbilidades cardiovasculares y pulmonares aumentan el riesgo de la sedación en estos pacientes. La edad por sí misma no supone una contraindicación para la realización de ningún procedimiento endoscópico. Sin embargo, los ancianos representan una población con particularidades propias que obligan a revisar las características, los riesgos y los beneficios de los distintos procedimientos endoscópicos digestivos en este grupo de edad.
The dramatic increase in life expectancy is leading to a significant increase in the use of gastrointestinal endoscopy in the elderly. Taking into account these demographic changes, the use of gastrointestinal endoscopy in this age group is of great importance. Although these procedures are generally safe and well tolerated even in very elderly patients, the onset of physiological changes associated with aging and the increased prevalence of cardiovascular and pulmonary comorbidities raise the risk of sedation related complications in these patients. Age alone is not a contraindication for performing any endoscopic procedure. However, elderly patients have their own peculiarities that require a detailed review of the characteristics, risks and benefits of endoscopic procedures in this specific context.
Indications for and diagnostic yield of capsule endoscopy in the elderly
2018, Revista de Gastroenterologia de Mexico
La creciente población anciana y el uso amplio de la endoscopia por cápsula han llevado a una cantidad mayor de procedimientos en aquellos pacientes. El objetivo del presente estudio fue valorar la utilidad de la endoscopia por cápsula en pacientes mayores.
Se clasificó a todos los pacientes consecutivos en nuestro centro sometidos a cápsula endoscópica (CE) dentro del periodo de tiempo 2004-2016 como mayores (≥75 años) y más jóvenes. Los hallazgos y el rendimiento de diagnóstico se valoraron comparativamente.
De 2,311 pacientes (edad promedio: 59.5 ± 19.23 años, 44.48% hombres), 648 se encontraban en el grupo de mayores y 1,663 en el grupo de más jóvenes. El tiempo de tránsito gástrico fue más corto en los pacientes mayores (p=0.001), mientras que el tiempo de tránsito del intestino delgado fue más corto en el grupo de pacientes más jóvenes (p<0.001). El rendimiento de diagnóstico global fue más alto en los ancianos (50.66% vs. 41.19%, p<0.001). El sangrado gastrointestinal de origen oscuro fue la indicación más frecuente para la endoscopia por cápsula en los ancianos (90.4% vs. 53.77%, p<0.001), logrando un rendimiento de diagnóstico más alto que en la población más joven (51.47% vs. 42.76%, p=0.002), mientras que la enfermedad de Crohn, sospecha o conocimiento de neoplasmas/pólipos, síndrome de malabsorción, y dolor abdominal fueron las indicaciones en el grupo de pacientes más jovenes. Tales indicaciones fueron poco comunes en el grupo de mayores. Se diagnosticó con mayor frecuencia las lesiones vasculares y el sangrado activo en los pacientes mayores, mientras que las úlceras/erosiones y la atrofia muscular fueron más comúnes en los pacientes más jóvenes (p<0.001).
La endoscopia por cápsula logró un rendimiento de diagnóstico global más alto en los pacientes ancianos. La indicación de sangrado gastrointestinal de origen oscuro para endoscopia por cápsula fue mucho más frecuente en el grupo de edad avanzada y presentó un rendimiento de diagnóstico mayor.
The growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients.
All consecutive patients undergoing capsule endoscopy at our center within the time frame of 2004-2016 were classified as older (≥75 years of age) and younger. Findings and diagnostic yield were comparatively assessed.
Of 2311 patients (mean age: 59.5 ± 19.23 years, 44.48% male), 648 were in the older group and 1663 in the younger group. Gastric transit time was shorter in the older patients (p=0.001), whereas small bowel transit time was shorter in the younger patients (p<0.001). Overall diagnostic yield in the elderly was higher (50.66% vs. 41.19%, p<0.001). Obscure gastrointestinal bleeding was the most frequent indication for capsule endoscopy in the elderly (90.4% vs. 53.77%, p<0.001), achieving a higher diagnostic yield than in the younger population (51.47% vs. 42.76%, p=0.002), whereas Crohn's disease, suspected or known neoplasms/polyps, malabsorption syndrome, and abdominal pain were the indications in the younger patient group. Such indications were rare in the older group. Vascular lesions and active bleeding were more frequently diagnosed in the older patients, whereas ulcers/erosions and mucosal atrophy were more common in the younger patients (p<0.001).
Capsule endoscopy achieved a higher overall diagnostic yield in the elderly patients. Obscure gastrointestinal bleeding indication for capsule endoscopy was much more frequent in the advanced-age group and had a higher diagnostic yield.
Magnetic-controlled capsule endoscopy performance in aging patients
2023, BMC Gastroenterology
The professional background of a referring physician predicts the diagnostic yield of small bowel capsule endoscopy in suspected small bowel bleeding
2023, Endoscopy International Open
Efficacy and safety of capsule endoscopy in octogenarian patients: a retrospective study
2023, Minerva Gastroenterology

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Short ReportIs capsule endoscopy appropriate for elderly patients? The influence of ageing on findings and diagnostic yield: An Italian retrospective study

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Patients and methods

Results

Discussion

Conflict of interest

Gastrointestinal Endoscopy

Gastrointestinal Endoscopy

Gastroenterology

Gastroenterology Clinics of North America

Gastroenterology Clinics of North America

Gastroenterology

Gastrointestinal Endoscopy

International Journal of Gerontology

The utility of capsule endoscopy small bowel surveillance in patients with polyposis

American Journal of Gastroenterology

A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn's disease

American Journal of Gastroenterology

Video capsule enteroscopy in the diagnosis of celiac disease: a multicenter study

American Journal of Gastroenterology

Aging of population

Statistics in focus, population and social conditions

Short Report
Is capsule endoscopy appropriate for elderly patients? The influence of ageing on findings and diagnostic yield: An Italian retrospective study