title: Endoscopic submucosal dissection for early gastric neoplasms in elderly patients.
abstract: OBJECTIVE
  To retrospectively evaluate the safety and feasibility of endoscopic submucosal dissection (ESD) for the treatment of early gastric cancer (EGC) in elderly patients ≥75 years of age.
  
  
  METHODS
  One hundred seventy-one patients (187 lesions) treated with ESD from January 2010 to September 2013 were enrolled in our study. Subjects were classified into two groups: elderly (age ≥75 years) or non-elderly (age <75 years). Clinicopathological characteristics, resectability, curability, complications, rates of local recurrence, and residual disease were evaluated. Association of clinicopathological characteristics of the lesions with immediate bleeding was analyzed.
  
  
  RESULTS
  No significant differences in clinical characteristics were observed. The incidences of comorbidity were significantly different between the elderly group and the non-elderly group (P<.001). Of the elderly patients, 54.3% had two or more underlying diseases compared with 18.4% of the non-elderly patients (P<.001). Of the 98.0% of elderly patients and 97.1% of younger patients who received en bloc resection, curative resection reached 94.1% and 96.3%, respectively. Immediate bleeding occurred in 15.2% of the elderly group and 4.8% of the non-elderly group (P=.044). Operation time differed significantly (P=.039). No apparent discrepancy was observed in perforation and delayed bleeding. The differences in the invasion depth were considered between the two groups (P=.001). Logistic regression analysis revealed that the rate of immediate bleeding was associated with invasion depth (P=.003). There were no differences in the follow-up period and rates of local recurrence and residual disease.
  
  
  CONCLUSIONS
  ESD is safe and feasible for elderly patients in the era of a graying population. Higher risk of immediate bleeding and longer operation time should be concerned.
authors.affiliation: 1 Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China .
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Lijiang
authors.initials: L
authors.lastname: Huang
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.forename: Feng
authors.initials: F
authors.lastname: Ji
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome