Association Between Charlson Comorbidity Index and Complications of Endoscopic Resection of Gastric Neoplasms in Elderly Patients

Abstract

Background: Although endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities. Further, the relationship between comorbidities and complications of endoscopic resection is not well established. Therefore, we aimed to evaluate the efficacy and safety of endoscopic resection of gastric epithelial neoplasms in extremely elderly patients. Methods: From October 2008 to December 2017, 4475 consecutive patients underwent endoscopic resection of gastric epithelial neoplasms. Among them, 242 were 75 years or older. We assessed Charlson comorbidity index (CCI) scores, procedural outcomes, and procedure- and sedation-related complications related to endoscopic resection. Results: Mean patient age was 78.7 ± 3.2 years. Of the 242 patients, 124 (51.2%) had low-grade dysplasia and 112 (46.3%) had adenocarcinoma. The most common comorbidity was hypertension (55.4%), followed by diabetes (23.1%). The mean CCI score was 1.67 ± 1.43. Sixty patients (24.8%) had a CCI score ≥ 3. During the procedure, 10 (4.1%) patients had desaturation that recovered by flumazenil use with mask (n=2) or Ambu bag (n=3) ventilation. During subsequent admission, atelectasis or pneumonia occurred in 45 (18.6%) patients, post-procedural bleeding in 12 (5.0%), and perforation in 3 (1.2%). Respiratory complications were more common in patients with a CCI score ≥ 3 (20/60, 33.3%) than in those with a CCI score < 3 (25/182, 13.7%, P=0.002). Conclusions: CCI score is related to respiratory complications of endoscopic resection in extremely elderly patients. Endoscopic resection must be performed cautiously, particularly in elderly patients with a high CCI score, to prevent respiratory complications.

Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

“…This is relevant irrespective of whether the patient undergoes advanced endoscopy under a general anesthetic or conscious sedation. While the Charlson co-morbidity index [33,34] and clinical frailty scale [35] have also been used to assess risk within endoscopy, these are supported by only a few smaller studies. Further work is required to determine the optimal modality to assess fitness for advanced endoscopic procedures.…”

Predictors of ICU admission associated with gastrointestinal endoscopy in medical inpatients: A retrospective cohort study

“…3 Next, a large proportion of medical patients have a significant burden of comorbid diseases, which require concurrent assessment and management. 4 Also, these procedures often require sedation and anesthesia, which have respiratory and cardiovascular sequelae and may increase the risk of complications. 5 A subset of patients undergoing endoscopic procedures require admission to intensive care units (ICU) for close monitoring and ongoing management.…”

“…First, endoscopic procedures are often emergently performed in hemodynamically unstable patients for acute gastrointestinal bleeding, a condition with associated in‐hospital mortality of 10% 3 . Next, a large proportion of medical patients have a significant burden of comorbid diseases, which require concurrent assessment and management 4 . Also, these procedures often require sedation and anesthesia, which have respiratory and cardiovascular sequelae and may increase the risk of complications 5 .…”