Perioperative Complications of Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Japanese Patients 75 Years of Age or Older

Abstract

Objective The number of endoscopic submucosal dissection (ESD) procedures for early gastric cancers among patients 75 years of age or older has been increasing. We herein examined both the outcomes and complications of ESD in elderly patients. Methods We investigated the effects of underlying diseases, lesion characteristics, treatment outcomes and complications during and in the postoperative periods of ESD among elderly patients 75 years of age or older versus non-elderly patients less than 75 years of age. Patients A total of 318 early gastric cancers in consecutive 307 patients, all of whom underwent ESD for gastric cancer, were included in this study. Results The number of patients with hypertension and ischemic heart disease was significantly higher in the elderly group than in the non-elderly group. The proportion of lesions with an absolute indication, extended indication or no indication was not significantly different between the groups. During the ESD procedure, the use of atropine sulfate for bradycardia was significantly more frequent in the elderly group. No significant differences were observed between the groups in terms of the treatment for hypertension, oxygen administration or incidence of perforation. In addition, there were no significant differences with respect to oxygen administration, postoperative bleeding or the occurrence of fever and/or pneumonia after the ESD procedure. Conclusion Although bradycardia was more frequently observed in the elderly patients during ESD in this study, ESD was performed safely and managed appropriately, with infrequent postoperative complications. ESD appears to be effective, even in elderly patients.

Efficacy, Safety, and Overall Quality of Life of Endoscopic Submucosal Dissection for Early Colorectal Cancer in Elderly Patients

“…In our study, we demonstrated that there was no significant difference in the mean procedure time between elderly and nonelderly patients, which is in line with a study from Japan [3]. Similarly, there were no significant differences in hospitalization days, complete resection, and en bloc resection between the two groups.…”

“…In most previous cases, perforation was treated conservatively [3]; similarly, in this study, the episode was solved very well with clipping, and no case required surgical intervention. In most previous studies, larger lesion (>20 mm), hypertension, massive submucosal invasion, tumor location, and lack of experience in ESD were deemed to be the risk factors for perforation during and after ESD [3, 24]. …”

“…However, the incidence of chronic disease may increase with increasing age; elderly patients with systemic diseases, such as diabetes and high blood pressure, together with poor gastrointestinal function, might not be able to endure such severe surgical trauma [3]. Endoscopic submucosal dissection (ESD) has been proven to be an effective therapeutic method for ECC, achieving the same curative effects [3, 4]. Unfortunately, studies reporting the treatment of ECC by ESD in elderly patients are lacking in China.…”

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

“…48 After meta-analysis, male sex, cardiopathy, cirrhosis, and chronic kidney disease were significantly associated with PPB. Among patients with chronic kidney disease, dialysis was associated with an increased PPB risk ( 16,27,35,52,53,56,75 did not clearly report AT management (pooled PPB, 3.6%), whereas this was adequately reported in the remaining studies.…”

“…Age was not identified as a risk factor in most studies, with only 1 study reporting that younger patients may be at higher risk for PPB. 34 Furthermore, 10 studies found no significant differences in elderly patients, 19,25,30,[35][36][37][38][39][40][41] although 1 study identified age > 80 years as an independent risk factor for PPB. 42 PPB rates were similar between genders in most studies, [13][14][15][16][17][18][20][21][22][23][25][26][27][28][29][30][31][32][33][34]36,39,[42][43][44] with only 1 study reporting an association male sex associated with PPB.…”