Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for superficial esophageal neoplasia. Is it safe for elderly patients?
BACKGROUND
Safety and efficacy of endoscopic submucosal dissection (ESD) for esophageal neoplasias have not been adequately investigated in elderly patients. This study was designed to evaluate the safety and efficacy of ESD for esophageal neoplasias in elderly patients.


METHODS
Fifty-three superficial esophageal neoplasias treated with ESD using a combination of small-caliber-tip transparent hood and flex knife from May 2006 to June 2009 were divided into elderly group (aged 70 years or older: 25 lesions in 23 patients) and nonelderly group (younger than aged 70 years: 28 lesions in 25 patients). Therapeutic efficacy, complications, and follow-up results were evaluated retrospectively.


RESULTS
The history of cerebral infarction or cardiopulmonary disease and the usage of antiplatelet agents or anticoagulants were significantly higher in elderly group (p 0.0050 and p 0.0013, respectively). Median procedural times in the elderly group and the nonelderly group were 93 ± 53 (range, 42-235) min and 95 ± 55 (range, 40-230) min (p 0.73), respectively. Median sizes of the neoplasias and the resected specimens were 14 ± 11 (range, 5-45) mm and 15 ± 17 (range, 5-83) mm (p 0.56), and 35 ± 12 (range, 18-60) mm and 38 ± 17 (range, 18-90) mm (p 0.38), respectively. En bloc resection rate was 100% in each group. Body temperature and white blood cell counts of the next day after ESD were significantly higher in the nonelderly group than in the elderly group (p 0.0087 and p 0.0043, respectively). There were no complications, such as postoperative bleeding or perforation, in each group. The median follow-up period of 23 ± 10 (range, 4-35) months in the elderly group revealed no local or distant metastasis.


CONCLUSIONS
ESD with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasia in elderly and nonelderly patients.
Ishii
Naoki
N
Department of Gastroenterology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan. naoishi@luke.or.jp
Uchida
Shino
S
Itoh
Toshiyuki
T
Horiki
Noriyuki
N
Matsuda
Michitaka
M
Setoyama
Takeshi
T
Suzuki
Shoko
S
Uemura
Masayo
M
Iizuka
Yusuke
Y
Fukuda
Katsuyuki
K
Suzuki
Koyu
K
Fujita
Yoshiyuki
Y
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002404:Catheterization; D004210:Dissection / Q000295:instrumentation / Q000379:methods; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D016629:Esophagectomy / Q000295:instrumentation / Q000379:methods*; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants