title: Utility and problems of endoscopic submucosal dissection for early gastric cancer in elderly patients.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is reported to be a safe and reliable procedure for the elderly, but these reports could have already had a bias at the time ESD was performed. However, the reports have not clearly stated the criteria of indications. In the present study, we retrospectively elucidated the usefulness and problems of ESD for early gastric cancer in elderly patients (≥ 65 years) in comparison with non-elderly patients.
  
  
  METHODS
  The subjects were selected from 412 consecutive patients with early gastric cancer (515 lesions) for which ESD was performed between June 2002 and February 2010. The following were used for analysis between groups: pre- and postoperative performance status (PS) of subjects, prevalence rates of pre-existing comorbidities, characteristics of lesions, treatment outcomes, durations of hospitalization, operating times, incidence rates of complications and durations of hospitalization, and postoperative hemorrhage rates, and duration of hospitalization in patients with anticoagulant therapy.
  
  
  RESULTS
  Of the lesions in the elderly, four patients (1.0%) were elderly with a PS of 3. The PS increased to six patients (1.6%) after the procedure. None of the non-elderly had a PS of 3 before or after the procedure. The ratio of patients with a pre-existing comorbidity was higher in the elderly than in the non-elderly. There were no differences between the two groups in the characteristics of the lesions, their duration of hospitalization, their operating times, or the incidence rates of complications. However, the elderly with perforations had a significantly longer hospitalization than the comparable non-elderly. The percentage of the patients taking anticoagulant drugs was significantly higher among the elderly. Of the patients on anticoagulant therapy, the duration of hospitalization tended to be longer in the elderly but no significant difference was found. None of the non-elderly with postoperative hemorrhage had received anticoagulant therapy. In the elderly with postoperative hemorrhage, 15.8% of the lesions were in those who had received anticoagulant therapy, indicating a significantly higher percentage of such lesions in the elderly group.
  
  
  CONCLUSIONS
  We conclude that ESD is useful in elderly patients because there is a similar risk as for the non-elderly if the approach is individualized, and the following are taken into consideration when making the final decision of performing ESD in an elderly patient: patients should have a PS of 0, 1, or 2; determine whether or not anticoagulant therapy can be discontinued and whether or not treatment can be performed reliably without complications.
authors.affiliation: Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tokioka
authors.forename: Eiji
authors.initials: E
authors.lastname: Umegaki
authors.forename: Mitsuyuki
authors.initials: M
authors.lastname: Murano
authors.forename: Nozomi
authors.initials: N
authors.lastname: Takeuchi
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Ken
authors.initials: K
authors.lastname: Kawakami
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Yoda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kojima
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015897:Comorbidity; D004210:Dissection / Q000009:adverse effects; D055088:Early Detection of Cancer; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants