Effectiveness and safety of screening colonoscopy in adults aged 75 years and older: a retrospective cohort study from Korea.

BACKGROUND/AIMS: The role of screening colonoscopy in older adults remains controversial because of procedural risks and limited life expectancy. We evaluated the diagnostic yield, procedural success, and safety of screening colonoscopy in patients aged ≥75 years. METHODS: We retrospectively reviewed 602 patients aged ≥75 years who underwent screening colonoscopy between January 2013 and December 2024. Patients were stratified into two age groups: 75-79 years (n=486) and ≥80 years (n=116). Baseline characteristics, procedural outcomes, and safety were compared. RESULTS: Baseline characteristics were comparable between groups. The detection rates were 10.5%, 6.8%, and 0.9% for non-advanced adenoma, advanced adenoma, and colorectal cancer, respectively. Cecal intubation success was high in both groups (98.1% vs. 99.1%, p=0.454), and adequate bowel preparation rates were similar (71.2% vs. 72.4%, p=0.880). Sedation was used less frequently in patients aged ≥80 years (65.5% vs. 76.7%, p=0.013). Complications were rare (1.5%) and comparable between groups, with only mild events. CONCLUSIONS: Screening colonoscopy in adults aged ≥75 years demonstrated high procedural success, substantial neoplasia detection rates, and low adverse event rates, with comparable outcomes in patients aged ≥80 years. However, overall clinical benefit should be interpreted cautiously, particularly in those aged ≥80 years, supporting an individualized approach.