Gastroscopy and colonoscopy in very old patients

Abstract

Tässä tutkimuksessa selvitettiin ylävatsan- ja paksusuolentähystyksen käyttöä hyvin iäkkäiden potilaiden tutkimisessa ja hoidossa. Tämän lisäksi tutkittiin hyvin iäkkäiden peptisen ulkustaudin erityispiirteitä. Eri osatutkimuksiin osallistui yli 80-vuotiaita potilaita Tampereen kaupungin vanhustenpalveluiden ja sisätautien yksiköistä sekä vanhainkodeista.

Peptinen ulkustauti havaittiin yleiseksi löydökseksi hyvin iäkkäiden ylävatsantähystyksissä. Ulkustautiin liittyi komplikaatioita lähes 70%:lla potilaita. Ylävatsantähystykset olivat turvallisia ja hyödyllisiä yli 80-vuotiailla potilailla. Tähystys selvitti vaivan syyn 60%:lla potilaista ja aiheutti lääkemuutoksia yli kolmella neljäsosalla potilaista.

Paksusuolentähystyksissä ei havaittu merkittäviä komplikaatioita liittyen suolen esivalmisteluun tai itse tutkimuksiin. Natriumfosfaatti ja polyetyleeniglykolityhjennykset olivat yhtä tehokkaita ja hyvin siedettyjä vanoilla potilailla. Vatsavaivat olivat yleisiä hyvin iäkkäillä.Suurin osa potilaista halusi, iästä riippumatta, asiallisia tutkimuksia ja hoitoja vatsavaivoihinsa.

Tämä tutkimus osoittaa hyvin iäkkäiden vatsavaivojen yleisyyden ja halun tulla tutkituksi ja hoidetuksi asianmukaisesti. Endoskopiat ovat turvallisia ja hyödyllisiä tutkimuksia iäkkäiden potilaiden hoidossa.

Gastroscopy and colonoscopy have become the gold standard in investigating abdominal complaints. In this study the use of gastroscopy and colonoscopy in very old patients was studied. Peptic ulcer disease was studied as an example of common disease of the gastrointestinal tract in the very old.

In order to study peptic ulcer disease files from the 408 diagnostic gastroscopies performed on patients aged 80 years or more in the geriatric department of the Tampere City Hospital were reviewed. Ulcer was found in 73 (18%) cases. The ulcers were divided almost evenly between duodenal and gastric ulcers. H. pylori was detected in only less than half of the cases. The most common symptoms were epigastric pain, nausea and vomiting. An ulcer caused complications in 69% of patients.

The reasons for and the outcome of gastroscopy in patients aged 85 years or more were studied from 191 diagnostic gastroscopies. For more than half of the cases the reason for acute hospitalisation was also an indication for gastroscopy. The main indications for gastroscopy were epigastric pain (54%), anaemia (36%), vomiting (14%) and nausea (13%). The major clinical findings at gastroscopy were gastritis (67%), oesophagitis (31%) and peptic ulcer disease (25%). Endoscopy revealed the reason for patients symptoms in 60% of cases, and after gastroscopy medication was changed in more than three quarters of patients. Gastroscopy was a safe examination according to the studies; no deaths associated with it occurred. Very old patients had numerous arrhythmias during the recordings, but during gastroscopy no increase in these was observed. However, there was an increased number of VES after endoscopy in patients suffering from heart disease.

Optimal bowel preparation for colonoscopy was studied in very old patients by randomizing seventy-two patients aged 80 years or more to receive either NaP or PEG preparation. NaP and PEG preparations were almost equally tolerated and effective in very old inpatients. PEG preparation was assessed to be safer than NaP. It caused fewer changes in the clinical indicators of dehydration and in laboratory tests. Endoscopists evaluated the quality of preparation as good or excellent in 81% of cases in the NaP group and in 77% of cases in the PEG group. No clinically significant adverse effects occurred during the preparations or colonoscopies. The attitudes of 165 elderly patients to the examinations and treatments of gastrointestinal symptoms were assessed by using a 17-item postal questionnaire. Abdominal complaints were common among participants. Despite the high age of the participants, the vast majority (>80%) wanted to be properly examined and treated, even in the group of oldest old.

With advancing age many gastrointestinal diseases become more prevalent. In these studies elderly patients also frequently had abdominal symptoms. The majority of the oldest old were willing to undergo examinations and the diagnostic yield of the endoscopies was good. Endoscopic examinations were safe, no serious complications occurred. On the basis of this study gastroscopy and colonoscopy can be considered as safe and useful examinations in very old patients.