Colonoscopy with polypectomy is central to colorectal cancer prevention with an increasing number of older and comorbid patients undergoing endoscopic therapy. This audit aimed to evaluate whether higher Charlson Comorbitiy Index (CCI) scores were associated with an increased risk of post-procedural complications, hospitalisation, recurrence, and all-cause mortality during follow-up.

A retrospective review was performed of 194 consecutive patients who underwent colonoscopy with polypectomy for benign polyps between October 2018 and November 2022 at the South Eastern Health and Social Care Trust, Northern Ireland. Patients with malignant polyps or colorectal cancer were excluded. Data collected included CCI score, post-procedural bleeding, hospitalisation, polyp recurrence at surveillance colonoscopy, and all-cause mortality at follow-up. Patients were stratified into low (CCI ≤ 2), moderate (3–5), and high (≥ 6) comorbidity groups. Associations between CCI category and outcomes were tested with chi-square analysis.

A total of 194 patients were included (median CCI 3, range 0-10). 33.5% were low-CCI, 52.5% moderate-CCI and 14% high-CCI. 

Mortality:During follow-up, 18 patients (9.3%) died from all causes. All deaths occurred among patients with CCI ≥ 3. Mortality increased significantly with higher comorbidity, rising from 0% in low-CCI patients to 7.8% in moderate and 37.0% in high-CCI groups, showing a significant trend (χ² = 31.6, p < 0.001).

Complications:Post-polypectomy bleeding occurred in two patients (1.0%), one with CCI 1 and one with CCI 8. Nine patients (4.6%) required hospitalisation following the procedure, primarily within the moderate and high CCI groups.

Polyp recurrence:A total of 21 patients (10.8%) developed polyp recurrence during surveillance follow-up. Recurrence rates increased with higher comorbidity, 7.7% in low CCI, 6.9% in moderate CCI and 33.3% in high CCI. This indicates a statistically significant association between higher CCI and recurrence (p=0.004).

Recurrences were also analysed by surveillance interval:

First surveillance colonoscopy: 9 patients (43% of recurrences; 2 low-CCI, 4 moderate-CCI, 3 high-CCI). Two of these patients subsequently demonstrated persistent polyp detection at their next procedure (CCI 4 and 8). 

Second surveillance colonoscopy: 6 patients developed new recurrence (29%; 2 low, 1 moderate, 3 high CCI). One of these (CCI 10) had persistent recurrence at subsequent follow-up.

Third surveillance colonoscopy: 6 patients (29%; 1 low, 2 moderate, 3 high CCI)

This audit demonstrates a clear and statistically significant association between comorbidity burden and both all-cause mortality and polyp recurrence following colonoscopic polypectomy for benign polyps. Although immediate procedural complications were uncommon across all comorbidity groups, long-term outcomes differed substantially, with both mortality and recurrence increasing sharply in patients with a CCI ≥ 6.

Analysis of recurrence patterns revealed that patients with higher CCI scores not only had greater overall recurrence rates but were also more likely to experience persistent polyp detection across successive surveillance procedures. 

These findings suggest a potential threshold of CCI ≥ 6, beyond which the benefits of repeated endoscopic intervention for benign lesions may be outweighed by procedural burden and limited life expectancy. In such cases, an individualised approach including careful risk-benefit assessment should be considered.

Routine integration of frailty and comorbidity assessment into colonoscopy pathways may improve patient selection, guide individualised management, and support more informed discussions regarding the long-term risks and benefits of benign polypectomy in comorbid populations.