One-stop colonoscopy-based management of colorectal polyps and internal hemorrhoids in older adults: A real-world cohort study

Abstract

BACKGROUND

Older adults frequently present with coexisting colorectal neoplasia and internal hemorrhoids requiring endoscopic management. Managing these conditions across separate endoscopic sessions may increase procedural burden, particularly in older patients with multiple comorbidities.

AIM

To evaluate clinical outcomes and safety associated with one-stop colonoscopy-based endoscopic management for elderly patients in a real-world setting.

METHODS

This retrospective real-world cohort study enrolled consecutive adults (≥ 18 years) with Goligher grade I-III internal hemorrhoids receiving one-stop colonoscopy-based endoscopic management at a tertiary endoscopy center from July 2022 to September 2025. Colonoscopy and polypectomy (when indicated) were performed before hemorrhoid intervention during the same session. Patients were followed after treatment, with a median follow-up duration of 12 months. Clinical outcomes, safety and patient-reported indicators were compared between elderly (≥ 65 years) and non-elderly (< 65 years) groups.

RESULTS

A total of 661 patients were included (≥ 65 years, n = 100; < 65 years, n = 561). Elderly patients had higher prevalences of comorbidities, adenoma, advanced adenoma, and high-grade dysplasia. Symptom improvement was reported by 82.0% of elderly and 82.4% of non-elderly patients [risk difference: -0.4%; 95% confidence interval (CI): -9.5 to 6.8]. The overall rate of any adverse event was 12.0% in elderly patients and 11.6% in non-elderly patients (risk difference: 0.4%; 95%CI: -6.4 to 7.5). No serious adverse events were recorded in either group. Postprocedural discomfort, patient satisfaction, cost acceptance, and the need for more than one treatment session did not differ significantly. In multivariable analysis, age was not significantly associated with symptom improvement (adjusted odds ratio = 1.01, 95%CI: 0.99-1.02; P = 0.365). Exploratory subgroup analyses did not identify statistically significant age-related differences in the measured clinical outcomes, although subgroup sizes were limited.

CONCLUSION

One-stop colonoscopy-based endoscopic management was associated with high rates of symptom improvement and a low frequency of observed procedure-related adverse events in appropriately selected elderly patients. Observed clinical outcomes were generally similar between elderly and non-elderly patients. These findings support the clinical feasibility of this consolidated endoscopic strategy in selected older adults, while prospective comparative studies are needed to further establish its safety and potential advantages over staged management.

Keywords: Hemorrhoids; Older adults; Colonoscopy; Colorectal polyps; One-stop management; Endoscopic therapy

Core Tip: This retrospective real-world cohort study evaluated a one-stop colonoscopy-based strategy integrating diagnostic colonoscopy, polypectomy when indicated, and hemorrhoid treatment during a single session in older adults. Despite a higher comorbidity burden, elderly patients achieved > 80% symptom improvement, with a low frequency of observed adverse events, and age was not independently associated with symptom improvement. These findings support the clinical feasibility of a consolidated endoscopic strategy in appropriately selected older adults, while its potential advantages over staged management require prospective evaluation.