Introduction
Gastrointestinal disorders are major causes of complications among elderly individuals. With increased age, several gastrointestinal disorders cause severe problems in the adult population. In most cases, the lower gastrointestinal tract is commonly involved. Conditions like colorectal cancer, abdominal bleeding, and toxic megacolon are common among elderly people. Colonoscopy is a widely used diagnostic and therapeutic technique in such cases.
What Is Colonoscopy?
A colonoscopy is a diagnostic and therapeutic procedure to visualize and evaluate the large intestine. Apart from this, the terminal portion of the small intestine is evaluated through this procedure. In this procedure, a hand-held flexible tube-like device is inserted from the anus to visualize the internal anatomy of the large intestine. This device is comprised of a camera-like instrument known as a colonoscope.
A colonoscopy is a long cylindrical instrument with a length of 62.99 inches to 70.87 inches (160 to 180 centimeters). The diameter of the colonoscope ranges from 0.39 to 0.47 inches (1 to 1.2 centimeters). At the end of the colonoscope, the camera is located with two to three lenses. The viewing angle of the camera ranges from 140 to 170 degrees. Apart from this, LED lamps are produced from the emission of light. Also, two holes are present to pass the working ports. From these holes, irrigants and instruments are passed. The handle of the colonoscope is held with the left hand, and the right hand is used to manipulate and advance the scope near the anus. At the base of the handle, a scope is used to adjust its flexibility. This helps to pass difficult anatomical areas. Apart from this, two switches are located in the handle. These switches are adjusted for the scope's left and right movement and the scope's forward and backward movement.
Before beginning the procedure, release these switches and ensure the scope tip moves freely. It is crucial to do this step to avoid any discomfort to the patient and prevent any damage to the sensitive tissue in the anus. Neglecting this can complicate the procedure and make it harder to navigate tight junctions and turns, ultimately increasing the risk of accidental perforation. Different instruments like graspers, needles, snares, and clip appliers are often used and are inserted through the ports. These instruments are used to collect tissue samples.
What Is the Need for Colonoscopy in the Elderly?
The following medical conditions are the causes of colonoscopy in elderly people.
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Colorectal Cancer: Colorectal cancers can be seen in many diseases like ulcerative colitis and inflammatory bowel disease. Around 1.8 million people are affected by this condition every year. The survival of the patient mainly depends upon conditions like the staging of cancer, involvement of the lymph nodes, and the spread of the cancer. Sixty percent of patients suffering from colorectal cancers are above the age of 70. It is one of the main causes of death in Western countries.
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Inflammatory Bowel Diseases: Inflammatory bowel disease is a chronic inflammatory disease of the small intestine. This inflammation is caused by the abnormal immune response by the gut microflora. This includes two pathological conditions, which are ulcerative colitis and Crohn’s disease. Excessive expression of the inflammation leads to the destruction of the epithelial lining and causes intrusion of the bacteria, antigens, and other substances in the bloodstream.
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Colon Polyp: The incidence of colon polyps is almost 1.6 higher in elderly individuals than young ones. These growths in the colon lumen are related to risk factors like alcoholism, low fiber, and high-fat diet. In some cases, polyps may turn into a cancerous growth. In most cases, colon polyps cause abdominal pain and abdominal bleeding.
Such complications often cause symptoms like abdominal pain, discomfort, frequent passage of the stool, and blood in the stool. Also, symptoms like abdominal bleeding and conditions like diverticulum are indicative of colonoscopy. Positive test results for fecal occult blood test and iron deficiency anemia are indicative of probable colonoscopy.
How to Prepare the Elderly for Colonoscopy?
Popper bowel preparation is the key to a successful colonoscopy procedure. Adequate bowel preparation helps to evaluate anatomical details much more clearly. The most common solution used for bowel preparation is polyethylene glycol (PEG) electrolyte lavage solution. Other than this, sodium phosphate-type laxatives, PEG-3350 powder with Gatorade, and magnesium citrate can be used for bowel preparation. However, persons suffering from renal dysfunction should not consume sodium phosphate. Also, it is contraindicated for hypertensive patients taking an an angiotensin receptor blocker.
Magnesium citrate is contraindicated for persons having kidney disorders. Also, this may cause side effects like abdominal pain and vomiting. The polyethylene glycol (PEG) electrolyte lavage solution is ideal for elderly people. It usually takes three to four hours for bowel clearance. This formulation is taken the afternoon or evening before the procedure. However, bowel clearance with the help of polyethylene glycol (PEG) electrolyte lavage solution may lead to the loss of potassium ions from the body and electrolyte imbalance.
What Are the Precautions for Colonoscopy in Elderly Patients?
Certain precautions must be taken to avoid any adverse event caused by colonoscopy. It should be noted that in certain cases, colonoscopy should be avoided. These conditions are;
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Suspected cases of colon perforation.
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Patients suffering from fulminant colitis (a condition where the whole colon is inflamed) or toxic megacolon (severe inflammation of the colon leading to dilation of the colon).
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Patients with a history of recent myocardial infarction.
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Patients suffering from inflammation of the lining of the abdomen of peritonism.
Medical conditions like colonic diverticulum, tortuous colon, and adhesion of the colon may cause serious complications in elderly people. Such complexities may increase the chances of perforation during the procedure. Other than this, difficulty in achieving anesthesia or potential complications owing to conscious sedation may lead to an emergency during the colonoscopy procedure.
Conclusion
Colonoscopy is done in the elderly people for diagnostic and therapeutic purposes. In elderly persons, colonoscopy helps to identify changes like colorectal cancer and colon polyps. It is also indicated for persons suffering from ulcerative colitis and Crohn’s disease. However, precautions should be taken while doing colonoscopies in aged persons. Aging is associated with an increased incidence of complications during colonoscopy
