Is Frailty a Barrier to Colonoscopy? : Perspectives from a Prospective Geriatric Cohort

Background: Frailty is increasingly used to guide clinical decision-making in older adults; however, its role in predicting colonoscopy-related complications remains unclear. Although frailty theoretically increases vulnerability to physiological stressors, real-world evidence on its procedural impact in geriatric populations is limited. Methods: In this prospective observational cohort, adults aged ≥ 65 years undergoing colonoscopy at a tertiary geriatric clinic (2022–2025) were evaluated. Frailty was assessed using the Fried Frailty Phenotype and categorized as non/pre-frail or frail. Demographic, clinical, laboratory, and comprehensive geriatric assessment data were collected. The primary outcome was any pre- or periprocedural complication; secondary outcomes included total complication count and bleeding. Logistic regression and ROC curve analyses were performed. Results: A total of 119 patients were included; 53.8% were frail. Complications occurred in 43.8% of frail patients versus 27.3% of non- and pre-frail patients (p = 0.062). Although individual bleeding events were more frequent among frail participants (10.9% vs. 0%, p = 0.011), frailty was not independently associated with overall complications (adjusted OR 0.56; 95% CI: 0.24–1.35; p = 0.197). Frail individuals demonstrated lower albumin, hemoglobin, and iron parameters, but post-procedural declines in albumin and hemoglobin were observed across the entire cohort. Frailty showed poor discriminatory ability for predicting complications (AUC 0.521). No perforation or cardiopulmonary complications occurred. Conclusion: Frailty, as defined by the Fried phenotype, does not independently increase the risk of colonoscopy-related complications in older adults. When appropriate indications and individualized preparation are ensured, colonoscopy appears safe even in frail geriatric patients. Routine frailty assessment may support clinical decision-making but should not be viewed as a contraindication to colonoscopy. Further multicenter studies with larger samples are warranted to validate these findings.