Efficacy and safety of colorectal endoscopic submucosal dissection in patients with sarcopenia

Feasibility of Colorectal Endoscopic Submucosal Dissection in Elderly Patients: The Impact of Sarcopenia

“…Moreover, perforation was the most common CTCAE ≥ grade 3 event in both groups. Consistent with previous reports, the present study found no significant differences in certain treatment outcomes (e.g., perforation rate, delayed bleeding rate, PECS, en bloc resection rate, R0 resection rate, or curative resection rate), irrespective of the presence of sarcopenia, although the perforation rate was slightly higher and the procedure time was longer in the sarcopenia group [20]. Prolonged procedure time is a risk factor for perforation, and poor bowel preparation has been associated with prolonged procedure time [34].…”

“…To the best of our knowledge, this is the first study to demonstrate a short-term prognostic association between sarcopenia and colorectal ESD, as assessed by muscle mass and quality index. So far, only one report on the association between sarcopenia and short-term prognosis of colorectal ESD has been published, showing no significant differences between groups; however, the authors had defined sarcopenia only by the low muscle mass index, while ESD-related complications were not defined based on CTCAE [20]. According to the current sarcopenia guidelines, sarcopenia is characterized by an agerelated decline in muscle mass and strength and reduced physical functionality [11,12].…”

“…Perforation was diagnosed endoscopically or by the presence of free gas on X-ray or CT scans following ESD [7]. PECS was diagnosed in patients without perforation and with abdominal pain and fever of ≥37.5°C [20]. With the introduction of the clinical pathway, the length of hospital stay was 6 days if no complications occurred during hospitalization.…”

“…This retrospective study included patients aged ≥65 years who had undergone colorectal ESD at the University of Tokyo Hospital between January 2013 and December 2020. Exclusion criteria were as follows: (1) patients without a computed tomography (CT) scan within 3 months before colorectal ESD, (2) patients with a history of colorectal surgery, and (3) patients with active inflammatory bowel disease or familial adenomatous polyposis [9,19,20]. According to the preoperative CT findings, we divided patients into two groups: a sarcopenia group and a non-sarcopenia group.…”

“…Charlson comorbidity index, prognostic nutritional index, and geriatric nutritional risk index were calculated based on established definitions [21][22][23]. Tumor characteristics included histological classification (low-grade adenoma, high-grade adenoma, adenocarcinoma, sessile serrated lesion, and traditional serrated adenoma), tumor location, procedure time, resection size, tumor size, and morphology [10,20,24,25]. Tumor location was classified as the right colon (cecum, ascending, and transverse colon), left colon (descending and sigmoid colon), or rectum.…”