Collaborative Group of Geriatric Endoscopy, Chinese Society of Digestive Endoscopy
With the rapid aging of the population, the improvement of digestive endoscopy equipment and the advancement of endoscopic diagnosis and treatment technology, the opportunities for elderly patients to receive digestive endoscopy and treatment have also increased. China has developed digestive endoscopy diagnosis and treatment technology for decades and has accumulated rich clinical experience. It is necessary to summarize and standardize the digestive endoscopy operation technology of the elderly to improve our diagnosis and treatment technology. The World Health Organization defines the elderly as older than 65 years old. This group of people gradually declines in the function of various organs, and the proportion of patients with various underlying diseases is increasing. As the elderly get older, even if there are no special obstacles in daily life, endoscopy or treatment before the examination can easily cause complications. According to relevant reports, more than 70% of middle-aged and elderly patients have complications or accidental deaths during digestive endoscopy. Therefore, the process of endoscopic diagnosis and treatment of elderly patients requires great attention. This guideline lacks a large number of well-designed prospective studies. It mainly refers to relevant domestic and foreign literature and recognized expert opinions, and is only for reference in clinical practice.
1. Indications and contraindications:
The indications of digestive endoscopy in elderly patients are generally similar to those of other age groups. However, we must pay more attention to age-related diseases. Cardiac insufficiency, respiratory failure, disturbance of consciousness, and Alzheimer’s can be contraindicated for those who are difficult to cooperate in endoscopy. Increasing age of elderly patients is not a contraindication to endoscopy, but the risks of endoscopic diagnosis and treatment and the benefits of elderly patients should be carefully evaluated. The content, necessity, safety, characteristics of elderly patients, complications and treatment of complications of the endoscopy should be explained in detail for the patients and their families, and informed consent should be obtained.
2. Preparation before operation:
The preparation for the endoscopic operation of elderly patients is basically the same as that of other adults. Loosen the tie and belt, take out the movable dentures, relax the patient, relieve anxiety, and build the patient's trust in the doctor, which is essential for a smooth endoscopy. Taking laxatives to clear the intestines before colonoscopy can easily cause dehydration, electrolyte disturbances, and sometimes peripheral circulatory disorders, and even cause cerebral infarction and myocardial infarction. A proper amount of infusion can be performed before endoscopy, which is beneficial to reduce complications.
The use of high-frequency electricity in endoscopic treatment may cause electromagnetic interference of the pacemaker, causing the pacemaker to stop or detect false signals like ventricular fibrillation. Therefore, a pre-endoscopic evaluation is required, and a cardiologist should be consulted if necessary.
3. Medication before operation:
Before upper gastrointestinal endoscopy, oral pharyngeal anesthetics, such as 2% lidocaine glue, are used to locally anesthetize the throat. To avoid accidental swallowing and airway inhalation of elderly patients, 4% lidocaine solution can be used for spraying.
In lower gastrointestinal endoscopy, the addition of lidocaine in the lubricant can relieve the pain of hemorrhoid patients. Anticholinergic drugs can cause rapid pulse and heart palpitations. Elderly patients, especially those over 80 years old, have less saliva secretion and relatively slow gastrointestinal motility, so anticholinergic drugs may not be used. For elderly patients with hypertension, ischemic heart disease, arrhythmia, glaucoma, prostate hypertrophy, etc., glucagon 0.5~1.0mg intramuscular or intravenous injection can replace anticholinergic drugs. The application of sedatives for digestive endoscopy in elderly patients requires consideration of their sensitivity to sedatives and the increased risk of sedation. Therefore, try to avoid the use of sedatives. If necessary, choose sedatives with short half-life and few adverse reactions, and reduce the dose to 1/2~2/3 of the usual amount, and the administration concentration must be slowed down. Fentanyl is more effective than pethidine in elderly patients due to its fast onset and short half-life. Although propofol has a narrow safety window, it is safer to use in elderly patients.
4. Matters needing attention in operation:
Elderly patients have thinner gastrointestinal walls and increased mucosal fragility. Rough endoscopic operations should be avoided. Rapid inflation in a short period of time, gastrointestinal dilation, and increased vagus nerve excitement may lead to bradycardia. Therefore, the gas injection should be small and slow to avoid the sharp extension of the gastrointestinal tube wall. During the biopsy, small blood vessels in the mucosa should be avoided, and the number of biopsy blocks should be minimized to prevent bleeding and perforation. In addition, elderly patients with cerebral infarction, myocardial infarction and other diseases, such as the use of anticoagulants, antithrombotic drugs such as heparin, warfarin, should pay attention to bleeding during biopsy. After the operation, try to pull out the inflated body to reduce the feeling of fullness and pain. Nasal endoscopy can better maintain oxygen saturation and prevent arrhythmia during operation, which is suitable for elderly patients.
5. Care after operation:
After the operation is over, the patient’s pain should be cared for, and gratitude for assisting in the diagnosis, treatment and examination. At the same time, the patient’s vital signs should be observed, and the operating table should be slowly lowered. Patients who have been sedated should be sent to the resuscitation room with a wheelchair or flatbed to observe until they are fully awake. During colonoscopy, an assistant must be in front of the patient to observe the patient's status, which can prevent accidents.
For elderly patients, there is no age-specific difference in endoscopic diagnosis and treatment, but it is necessary to make a cautious judgment based on the risks and benefits of endoscopic diagnosis and treatment.