Sa1508 Long-Term Follow-up of Extremely Elderly Patients With Early Gastric Neoplasms Treated by Endoscopic Submucosal Dissection

Abstract

groups, respectively (P!0.001). Median follow up period was 32 months (range, 0147.4 months). The five-year overall survival rates were 96.7% and 95.3% for absolute and expanded indication group, respectively (pZ0.940). Local recurrence was observed in five tumors (0.3%) at 2, 2, 6, 19 and 34 months after first ESD (3 en bloc and 2 piecemeal resection). Extragastric recurrence occurred in two EGC cases (0.13%) meeting each AI and EI. The extragastric recurrence interval was 62 months in the AI group and 46 months in the EI group. At that time, endoscopic examination showed no evidence of local recurrence around ER scar area. Metachronous recurrence occurred in 49 EGC cases (2.7%) during follow-up period. The median metachronous recurrence interval was 27.0 months (range, 13-115 months). The cumulative incidence of metachronous recurrence is increased steadily. Conclusions: The expanded indication of ER for EGCs showed acceptable long-term outcomes. Endoscopic examination is required more than 5 years after ER for EGC because the cumulative incidence of metachronous recurrence is increased steadily. Extragatric recurrence occurred at least two years after ESD in most cases unlikely ordinary recurrence pattern of AGC. CT should be performed together with endoscopy for surveillance of recurrence after ER for EGC in the AI group as well as the EI group. Sa1508 Long-Term Follow-up of Extremely Elderly Patients With Early Gastric Neoplasms Treated by Endoscopic Submucosal Dissection Tatsuya Toyokawa*, Tomoki Inaba, Koichi Izumikawa, Isao Fujita, Shigenao Ishikawa, Jun Tomoda Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan; Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan Background: Endoscopic submucosal dissection (ESD) has been established as a standard treatment for early gastric neoplasms in Japan. Recently, ESD has gained momentum worldwide. With the increase in the aging population, the number of elderly patients undergoing ESD for the treatment of early gastric neoplasms has steadily increased. This study aimed to investigate the long-term clinical outcomes of early gastric neoplasm in patients aged S 85 years who underwent ESD. Methods: The study subjects were 1123 cases with early gastric neoplasms who underwent ESD from May 2003 to August 2010 at Fukuyama Medical Center, Kagawa Prefectural Centrall Hospital, and Mitoyo General Hospital. The patients were classified into two groups as follows: the elderly group (S 85-years-old) and the nonelderly group (! 85-years-old). We compared the characteristics of patients and lesions, treatment outcomes, procedure-related complications and prognosis between the two groups. Statistical analysis was performed using Mann-Whitney U-test and Chi-square test, p! 0.05 was considered to be statistically significant. Results: The elderly group included 62 cases and the non-elderly group included 1061 cases. The mean follow-up period was approximately 51 months. The female to male ratio was significantly higher in the elderly group than in the non-elderly group. The underlying incidences of hypertension and heart disease were significantly higher in the elderly group. The location, size and types of lesions were not significantly different between the two groups. The mean size of resected specimens from the elderly patients was larger than that from the non-elderly patients (39 mm vs. 35 mm). The en-bloc resection (97% vs. 93%) and curative resection rates (89% vs 84%) were high in both groups. The procedure time was similar between the two groups. No significant procedure-related complications, such as perforation or delayed bleeding, were observed in the two groups. The rates of residual disease or recurrence in both groups were very low (0% vs. 1.1%), and the differences were not significant. The death rate was significantly higher in the elderly group (26% vs. 7.1%) during the follow-up period. However the original disease was not the cause in either of the groups, and there were no significant differences in the reason for death or the period from ESD to death between the two groups. Conclusions: In this study, the treatment of early gastric neoplasms by ESD was equally effective in extremely elderly patients and non-elderly patients. Furthermore, it was elucidated that the death rate because of other diseases is higher in extremely elderly patients and that they have Data and Outcomes for Preand Post-Clipping Phases # of Colonscopies # of Patients # of Polyps Male/ Female Mean Age and Range Polypectomy Duration Mean and Range(minutes) Pre-Clipping 2121 55 65 36/19 69.3 (37-87) 17.47 (2-61)