Two of the above studies discussed safety of colonoscopy in elderly patients. Duncan found 8 major complications (0.6%) including 3 bleeds and 1 perforation in a series of 1199 colonoscopies6. Sardinha also reported a low rate of major bleeding (0.2%) and no perforation in 428 colonoscopies; this compared favorably with two other studies on elderly patients.10 Gatto et al took a random sample of Medicare patients who underwent a colonoscopy between 1991 and 1998. 39,286 colonoscopies were identified by CPT-4 codes; perforations within 7 days of the procedure were identified by ICD-9 codes. The average age was 74, and 21 % of patients were older than 80. The overall incidence of perforation was 0.19%; the authors found that the rate of perforation increased with age and the number of comorbidities12,13.