Modifications in Endoscopic Practice for the Elderly

Publication Date: November 1, 2013
Last Updated: March 14, 2022


We recommend that with optimal periprocedure evaluation and care, diagnostic and therapeutic endoscopic interventions can be safely performed in elderly patients. (M)

We recommend that electrolyte-balanced polyethylene glycol–based colonoscopy preparations be used in elderly individuals to avoid potentially harmful fluid and electrolyte shifts. (M)

We suggest using split-dosage cathartic bowel preparations in the elderly for colonoscopy preparation. (L)

We recommend evaluating the patient’s baseline functional status, cognitive ability, and capacity to understand the anticipated endoscopic procedure as part of the preprocedure assessment in the elderly. (M)

We recommend standard monitoring procedures in the elderly during moderate sedation with heightened awareness of this population’s increased response to sedatives. (M)

We recommend that lower initial doses of sedatives than standard adult dosing should be considered in the elderly and that titration should be more gradual to allow assessment of the full dose effect at each dose level. (M)

We suggest that practitioners exercise additional caution when performing colonoscopy in elderly patients because this procedure may confer a higher risk of adverse events. (L)

We recommend that colonoscopic screening and surveillance for colorectal cancer in patients of advanced age be individualized based on general health and comorbid medical illnesses. (M)

Recommendation Grading



Modifications in Endoscopic Practice for the Elderly

Authoring Organization

Publication Month/Year

November 1, 2013

Last Updated Month/Year

September 13, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Older adult

Health Care Settings

Emergency care, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse anesthetist, nurse, medical assistant, nurse practitioner, physician, physician assistant


Assessment and screening, Diagnosis, Prevention

Diseases/Conditions (MeSH)

D011315 - Preventive Medicine, D004724 - Endoscopy, D016099 - Endoscopy, Gastrointestinal, D005853 - Geriatrics


Colonoscopy Preparation, elderly endoscopy, Upper endoscopy, Endoscopic ultrasound

Source Citation

Early, D. S., Acosta, R. D., Chandrasekhara, V., Chathadi, K. V., Decker, G. A., Evans, J. A., … Cash, B. D. (2013). Modifications in endoscopic practice for the elderly. Gastrointestinal Endoscopy, 78(1), 1–7. doi:10.1016/j.gie.2013.04.161

Supplemental Methodology Resources

Data Supplement