The benefit of polypectomy during colonoscopy in an elderly, comorbid population remains unclear. Clinicians regularly struggle with balancing the often-uncertain natural history of polyp progression to symptomatic malignancy against the elevated risks of complications relating to diagnostic colonoscopy and polypectomy, and associated patient outcomes. The British Society of Gastroenterology (BSG) recently issued guidance to facilitate informed decision-making regarding polypectomy in those with limited life expectancy. We aimed to audit our baseline practice at the Mater Misericordiae University Hospital (MMUH) in the >80-year-old population and assess whether application of the BSG guidance would affect our polypectomy rate in this cohort. 

In this audit we retrospectively studied electronic health records at MMUH for all patients aged >80 years of age who were referred for (and subsequently underwent) colonoscopy and polypectomy from January 2024 to January 2025.

Data examined included procedure indication, comorbidities (analysed using the Charlson Comorbidity Index), the size/characteristics of polyps removed, complications (e.g., bleeding, perforation), and re-admissions/emergency visits within 90 days.

Compliance with new BSG recommendations was assessed.

Following pre-assessment, 58 (28M/30F, median age 81) patients proceeded to lower GI endoscopy (45 full colonoscopy, 13 left sided colonoscopy). 

The Charlson Co-Morbidity Index was median 6 (range 4-9). 

25/58 patients (43.1%) proceeded to polypectomy – 11 patients (1-5mm polyp removed), 3 patients (6-9mm), 7 patients (10-19mm), 4 patients (>20mm). 

12/58 (20.6%) patients had repeat scope recommended for ongoing polyp surveillance. 

Application of the new BSG guidance would have averted polypectomy in 14/25 (56%) of patients. 

Of the non-guideline adherent cases, anti-coagulation was withheld in 6/14 (43%)to facilitate polyp resection

Application of the recent BSG guidance on polypectomy in patients >80 years old with limited life expectancy would significantly reduce the polypectomy rate in our patient cohort. 

This would have important implications not only for patient safety but also resource use in endoscopy.