Abstract
BackgroundAlthough endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities. Further, the relationship between comorbidities and complications of endoscopic resection is not well established. Therefore, we aimed to evaluate the efficacy and safety of endoscopic resection of gastric epithelial neoplasms in extremely elderly patients.MethodsFrom October 2008 to December 2017, 4475 consecutive patients underwent endoscopic resection of gastric epithelial neoplasms. Among them, 242 were 75 years or older. We assessed Charlson comorbidity index (CCI) scores, procedural outcomes, and procedure- and sedation-related complications related to endoscopic resection.ResultsMean patient age was 78.7 ± 3.2 years. Of the 242 patients, 124 (51.2%) had low-grade dysplasia and 112 (46.3%) had adenocarcinoma. The most common comorbidity was hypertension (55.4%), followed by diabetes (23.1%). The mean CCI score was 1.67 ± 1.43. Sixty patients (24.8%) had a CCI score ≥ 3. During the procedure, 10 (4.1%) patients had desaturation that recovered by flumazenil use with mask (n = 2) or Ambu bag (n = 3) ventilation. During subsequent admission, atelectasis or pneumonia occurred in 45 (18.6%) patients, post-procedural bleeding in 12 (5.0%), and perforation in 3 (1.2%). Respiratory complications were more common in patients with a CCI score ≥ 3 (20/60, 33.3%) than in those with a CCI score < 3 (25/182, 13.7%, P = 0.002).ConclusionsCCI score is related to respiratory complications of endoscopic resection in extremely elderly patients. Endoscopic resection must be performed cautiously, particularly in elderly patients with a high CCI score, to prevent respiratory complications.
Highlights
Endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities
No studies to date have examined the relationship between Charlson comorbidity index (CCI) score and incidence of complications after endoscopic resection of gastric epithelial neoplasms in elderly patients
Our study demonstrated that: (1) endoscopic resection was effective and safe for extremely elderly (≥75 years of age) patients with gastric neoplasms under careful consideration; and (2) age and higher CCI score (≥3) were independent risk factors for atelectasis or pneumonia after endoscopic resection in extremely elderly patients
Summary
Endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities. A growing number of endoscopic treatments are performed for the elderly, and several reports have shown contrasting treatment outcomes and complications of endoscopic resection in elderly and nonelderly patients [4,5,6,7,8]. Patients, especially those aged 75 years or older (extremely elderly patients), have various comorbidities and functional disabilities that influence daily life [9, 10]. No studies to date have examined the relationship between CCI score and incidence of complications after endoscopic resection of gastric epithelial neoplasms in elderly patients
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