Endoscopic ultrasound: A safe procedure for elderly oncology patients?

Abstract

e21531 Background: Endoscopic ultrasound (EUS) has many indications in the management of gastrointestinal tumors, and has become pivotal in guiding therapy. While studies show that surgery in the elderly with malignancy causes increased morbidity and costs, no studies exist to assess the safety of EUS in this group. Methods: A single center retrospective analysis of patients who underwent EUS by two advanced endoscopists from April 2015 to December 2015 was performed. Patient demographics, procedure indications, final diagnoses, procedure length, sedation type, ASA classification, and intra-procedural complications, peri-procedural (immediate) complications, and post-procedural (24 hours after) complications were collected. Statistical analysis was done with Chi-square and comparison of mean tests. Results: 111 patients were identified with either a confirmed or suspected gastrointestinal malignancy out of 200 total patients included in the study. These patients included 38 with suspected pancreatic adenocarcinoma, one of which revealed pancreatic gastrinoma; 27 with suspected gastric adenocarcinoma or for staging; 17 with suspicious esophageal masses or for staging of squamous cell carcinoma or adenocarcinoma; 9 duodenal masses, 3 colorectal masses, 2 mediastinal masses, 1 biliary mass, 3 potential metastatic lesions to the GI system, and 8 patients with abdominal lymphadenopathy suspicious for malignancy. Patients over 65 years tended to have a lower risk of intra-procedure complications compared to those under 65, irrespective of all other factors including gender, performing endoscopist, and length of procedure (8.3% vs. 18.3%, p = 0.09). No significant differences were found in peri- and post-procedural complications between the over age 65 and under age 65 groups (4.0% vs. 1.6%, p = 0.44; 5.9% vs. 15.2%, p = 0.19). Conclusions: Due to the poor performance status often seen in the elderly oncology population, complications often arise from invasive procedures leading to increased morbidity, mortality, and costs. EUS aids in diagnosis, staging, and therapeutic decision-making of patients with gastrointestinal malignancies, and as this study shows, can be performed in older patients without incurring increased risks.