JGH open : an open access journal of gastroenterology and hepatology · 2026
Outcomes of Screening Colonoscopy in Older Adults: A Large Propensity-Matched Real-World Cohort Study.
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Shakarchi Taha, Khawar Muneeb, Malik Mohammad Azeem, Jamandlamudi Anuhya, Veettil Ihsan Noushad Karuppan, Komel Aqsa, Khawar Mirza Muhammad Hadeed, Agha Naima, Habib Muhammad, Ahmad Ishtiaq, Al-Abayechi Ban, Al-Khazraji Ahmed
Аннотация
BACKGROUND: The benefits and harms of screening colonoscopy after age 75 remain uncertain. Guidelines endorse individualized decisions given competing risks, but comparative data are limited.
METHODS: In the TriNetX US Collaborative Network, adults aged 75-90 years with a colorectal cancer screening encounter were matched 1:1 by colonoscopy within 3 months. Outcomes were assessed at 30 days, 1 year, and 5 years. Sensitivity analyses excluded pre-index anemia and, separately, fecal abnormalities and alarm symptoms; subsequent colonoscopy was counted through 5 years.
RESULTS: Matched cohorts comprised 58 315 pairs at 30 days, 61 497 at 1 year, and 69 821 at 5 years. Colonoscopy increased polyp detection (HR 4.43 [95% CI 4.15-4.73] at 30 days; 1.88 [1.82-1.95] at 5 years) and colorectal cancer detection (4.56 [3.62-5.74]; 1.78 [1.59-1.98]; all p ≤ 0.003). Five-year all-cause mortality was unchanged (HR 1.01 [0.97-1.05]; p = 0.741). Perforation rose at 5 years (HR 1.29 [1.02-1.63]; p = 0.033); gastrointestinal bleeding fell at 1 year (HR 0.90 [0.84-0.97]; p = 0.004). After exclusion of pre-index anemia (70 399 pairs), 5-year HRs remained 1.72 for polyps and 1.52 for cancer. In an indication-restricted cohort also excluding fecal abnormalities, weight loss, abdominal pain, and change in bowel habit (54 300 pairs), the 5-year HRs were 1.59 and 1.32. Subsequent colonoscopy from day 31 to year 5 was not more frequent after index screening (5.8% vs. 6.2%; HR 0.93).
CONCLUSION: Screening colonoscopy improved polyp and cancer detection but did not reduce 5-year all-cause mortality. The late perforation signal was not explained by more subsequent or therapeutic colonoscopy. Decisions after age 75 should be individualized.
METHODS: In the TriNetX US Collaborative Network, adults aged 75-90 years with a colorectal cancer screening encounter were matched 1:1 by colonoscopy within 3 months. Outcomes were assessed at 30 days, 1 year, and 5 years. Sensitivity analyses excluded pre-index anemia and, separately, fecal abnormalities and alarm symptoms; subsequent colonoscopy was counted through 5 years.
RESULTS: Matched cohorts comprised 58 315 pairs at 30 days, 61 497 at 1 year, and 69 821 at 5 years. Colonoscopy increased polyp detection (HR 4.43 [95% CI 4.15-4.73] at 30 days; 1.88 [1.82-1.95] at 5 years) and colorectal cancer detection (4.56 [3.62-5.74]; 1.78 [1.59-1.98]; all p ≤ 0.003). Five-year all-cause mortality was unchanged (HR 1.01 [0.97-1.05]; p = 0.741). Perforation rose at 5 years (HR 1.29 [1.02-1.63]; p = 0.033); gastrointestinal bleeding fell at 1 year (HR 0.90 [0.84-0.97]; p = 0.004). After exclusion of pre-index anemia (70 399 pairs), 5-year HRs remained 1.72 for polyps and 1.52 for cancer. In an indication-restricted cohort also excluding fecal abnormalities, weight loss, abdominal pain, and change in bowel habit (54 300 pairs), the 5-year HRs were 1.59 and 1.32. Subsequent colonoscopy from day 31 to year 5 was not more frequent after index screening (5.8% vs. 6.2%; HR 0.93).
CONCLUSION: Screening colonoscopy improved polyp and cancer detection but did not reduce 5-year all-cause mortality. The late perforation signal was not explained by more subsequent or therapeutic colonoscopy. Decisions after age 75 should be individualized.