Sedation and bowel preparation for colonoscopy in elderly: A nationwide survey in Ireland.

Hytham Hamid, Mr, Adeel Zafar, Mr, Brian Egan, Dr, Luke O’Donnell, Dr, Iqbal Khan, Mr. Departments of Surgery and Gastroenterology, Mayo General Hospital, Ireland..

Background and Aims: The practice of colonoscopy in elderly is not standardized in Europe. Recent European Society of Gastrointestinal Endoscopy (ESGE) guidelines are concerned primarily with safety aspects of the procedure in this age group. In view of this, a national survey of sedation and bowel preparation for colonoscopy in elderly was performed to assess the current practice in Ireland.

Material and Methods: A structured 21 item questionnaire was mailed to 204 consultant surgeons and adult gastroenterologists. Endoscopists’ routine of elderly patients monitoring, sedation, and bowel preparation methods for colonoscopy were assessed. The endoscopists’ perceived barriers to optimal bowel preparation were also evaluated.

Results: A 48.5% (99 endoscopists) response was obtained. The respondents performed an average of 13 colonoscopies per week. The majority of colonoscopies in elderly patients (95%) were carried out under sedation. The most frequently used agent for sedation in elderly was midazolam in 90%, while propofol and diazepam were preferred in 6% and 4% of the cases, respectively. Respondents routinely monitored vital signs and pulse oximetry (100%), and/or electrocardiography (35%), and supplemental oxygen was routinely administered in 90% of the cases. Endoscopists’ satisfaction with sedation was greater among those using propofol than in the groups using conventional sedation (score on a 10-point visual analogue scale, 9.5±0.8 vs. 8.3±0.9, p = 0.003). Sixty-two percent of the respondents used polyethylene glycol for bowel preparation in elderly, and 88% respondents believed that patients-related factors were the main barriers to optimal bowel preparation.

Conclusion: Use of sedation and physiologic monitoring is currently the standard practice during colonoscopy in elderly Irish patients. Benzodiazepines remain the most commonly used sedative agents. Patients-related barriers are the prime contributors to poor bowel preparation in the geriatric population.

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