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Teachable Moment
Less Is More
January 22, 2019

Elective Colonoscopy in Older Adults—Minimizing Risks: A Teachable Moment

Author Affiliations
  • 1Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
  • 2Center for Clinical Management Research, Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
  • 3Department of Internal Medicine, University of Michigan Health System, Ann Arbor
JAMA Intern Med. 2019;179(3):425-426. doi:10.1001/jamainternmed.2018.7666

A 92-year-old man with chronic obstructive pulmonary disease and gastroesophageal reflux disease presented to the emergency department (ED) with hematochezia. He lived in an assisted-living community and enjoyed walking outside and spending time with his grandchildren. Findings of the patient’s last colonoscopy at age 75 years were normal, but a colonoscopy performed at the time of ED presentation revealed sigmoid diverticulosis as the suspected bleeding source. Two large polyps (1.2 and 1.5 cm) in the proximal colon were left in situ. The bleeding resolved spontaneously, and the patient was discharged home.

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    1 Comment for this article
    Or, actually caring for the patient
    Scott Helmers, M.D. | Retired
    If hospitals focused more on patients, not profits, this 92-year-old man might have stayed overnight, possibly allowing his deteriorating status after the colonoscopy to be detected and acted on more expeditiously. He might also have had his intake regulated so that his gastric contents were minimal.