title: Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is gaining acceptance among endoscopists for its efficacy, especially in Japan. Elderly patients often have operative risk due to comorbid diseases, and the feasibility of this treatment for such patients should be investigated. The aim of this study is to evaluate the efficacy and safety of ESD in elderly patients.
  
  
  METHODS
  Among 308 gastric neoplasms treated by ESD from 2000 to 2004 in one hospital, 49 lesions were discovered in 42 elderly patients who were 75 years of age or older. Indication criteria for ESD were gastric neoplasms with no apparent massive submucosal invasion diagnosed by endoscopy. The en bloc plus R0 resection rate and complications were assessed in comparison with younger patients.
  
  
  RESULTS
  The average age of the patients was 78.9 years (range 75-88 years). Of these patients, 24 (57%) had comorbid diseases. The complete en bloc plus R0 resection rate was 96% (47/49). Postoperative bleeding requiring emergency endoscopy occurred in three patients (7%). Perforation during ESD occurred in one patient (2%), and was immediately closed with endoclips and managed by conservative medical treatment. The en bloc plus R0 resection rate and complication rate in elderly patients were not significantly different from those of younger patients.
  
  
  CONCLUSIONS
  These results indicate that ESD could be a safe and reliable treatment for gastric neoplasms in elderly patients.
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Kakushima
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Shinya
authors.initials: S
authors.lastname: Kodashima
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Muraki
authors.forename: Ayako
authors.initials: A
authors.lastname: Tateishi
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005753:Gastric Mucosa; D005773:Gastroscopy; D006801:Humans; D007564:Japan; D013274:Stomach Neoplasms / Q000601:surgery*