Clinical outcomes of ESD for early gastric neoplasms in elderly patients.
BACKGROUND
Endoscopic submucosal dissection (ESD) is a standard treatment in Japan for early gastric neoplasms. With an increase in elderly population, the number of elderly patients in whom ESD performed has also steadily increased.


OBJECTIVE
The aim of study was to evaluate the effectiveness of and problems associated with ESD for early gastric neoplasms in elderly patients. Subjects were 514 patients (586 lesions) with early gastric neoplasms performed ESD at two institutions. The patients were classified into an elderly group (age ≥ 75 years) and a nonelderly group (age < 75 years). We compared the characteristics of patients and lesions, treatment results, ESD-related complications and prognosis between the two groups.


RESULTS
The elderly group included 200 patients (229 lesions), and the nonelderly group included 314 patients (357 lesions). The incidences of underlying disease, such as hypertension and heart disease, and the rate of antiplatelet agents use were significantly higher in the elderly group. En bloc and curative resection rates were high in both groups. The bleeding rate was significantly higher in the elderly group. Residual disease or recurrence rates were very low in both groups. The death rate due to other diseases was significantly higher in the elderly group.


CONCLUSIONS
This study demonstrates the efficacy of ESD in both elderly and nonelderly patients. However, we must be attentive to ESD-related bleeding, death caused by other diseases, and underlying diseases when we perform ESD in elderly patients.
Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama city, Hiroshima, Japan. toyotatu@kmail.plala.or.jp
Tatsuya
T
Toyokawa
Isao
I
Fujita
Tamiya
T
Morikawa
Akiko
A
Okamoto
Rika
R
Miyasaka
Kazuo
K
Watanabe
Joichiro
J
Horii
Motohiro
M
Gobaru
Masako
M
Terao
Takako
T
Murakami
Jun
J
Tomoda
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000236:Adenoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods*; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome