Practice Patterns and Predictors of Stopping Colonoscopy in Older Adults With Colorectal Polyps

Background & Aims Older adults with colorectal polyps undergo frequent surveillance colonoscopy. There is no specific guidance regarding when to stop surveillance. We aimed to characterize endoscopist recommendations regarding surveillance colonoscopy in older adults and identify patient, procedure, and endoscopist characteristics associated with recommendations to stop. Methods This was a retrospective cohort study at a single academic medical center of adults aged ≥75 years who underwent colonoscopy for polyp surveillance or screening during which polyps were found. The primary outcome was a recommendation to stop surveillance. Predictors examined included patient age, sex, family history of colorectal cancer, polyp findings, and endoscopist sex and years in practice. Associations were evaluated using multilevel logistic regression. Results Among 1426 colonoscopies performed by 17 endoscopists, 34.6% contained a recommendation to stop and 52.3% to continue. Older patients were more likely to receive a recommendation to stop, including those 80–84 years (odds ratio [OR], 7.7; 95% confidence interval [CI], 4.8–12.3) and ≥85 years (OR, 9.0; 95% CI, 3.3–24.6), compared with those 75–79 years. Family history of colorectal cancer (OR, 0.42; 95% CI, 0.24–0.74) and a history of low-risk (OR, 0.17; 95% CI, 0.11–0.24) or high-risk (OR, 0.02; 95% CI, 0.01–0.04) polyps were inversely associated with recommendations to stop. The likelihood of a recommendation to stop varied significantly across endoscopists. Conclusions Only 35% of adults ≥75 years of age are recommended to stop surveillance colonoscopy. The presence of polyps was strongly associated with fewer recommendations to stop. The variation in endoscopist recommendations highlights an opportunity to better standardize recommendations following colonoscopy in older adults.