Tu1700 Carbon Dioxide Versus Air Insufflation on Patient Comfort Post-Colonoscopy: A Meta-Analysis of Randomized Controlled Trials

Abstract

conventional endoscopic mucosal resection (EMR). In the present study, we elucidated the indication criteria of ESD and examined its usefulness for early gastric cancer in elderly patients (65 years) by comparison with non-elderly patients. Methods: The subjects were selected from 515 consecutive lesions with early gastric cancer for which ESD was performed between June 2002 and February 2010. Results: In the elderly, four (1.0%) were from the elderly with a Performance Status: PS of 3. The number of PS increased to six (1.6%) after the procedure. None of the non-elderly had a PS of 3 before or after the procedure. In the elderly, 76.9% were from the elderly with preexisting comorbidity. In the non-elderly, 43.4% were from the non-elderly with preexisting comorbidity. There were no differences between the two groups in the distribution of the following: location of gastric lesions where ESD was performed, macroscopic type, tumor size, histological type, depth of invasion, and category of lesions. Overall, the two groups had no significant difference in their durations of hospitalization. However, the elderly with perforation had significantly longer duration of hospitalization compared to the elderly without perforation. The elderly and non-elderly groups also had no significant difference in their operating times for ESD or in the incidence rates of complications. In the elderly, 10.2% were from the elderly who had anti-coagulant therapy. In the non-elderly, 1.4% were from the non-elderly who had anti-coagulant therapy. The percentage was significantly higher in the elderly. In patients with anti-coagulant therapy, the durations of hospitalization were 15.5 and 10.0 days in the elderly and nonelderly groups, respectively. The duration tended to be longer in the elderly but no significant difference was found. Overall, there was no significant difference in the incidence of postoperative hemorrhage. There was postoperative hemorrhage in 5.1% of the lesions in the elderly group and 4.9% of the lesions in the non-elderly group. None of the non-elderly with postoperative hemorrhage had received anti-coagulant therapy. In the elderly with postoperative hemorrhage, 15.8% of the lesions were from the elderly who had received anticoagulant therapy, indicating a significantly higher percentage of such lesions in the elderly group. Conclusion: We conclude that the following should be considered when making the final decision of performing ESD in elderly patients. These patients should have a PS of 0, 1, or 2. One should determine whether or not anti-coagulant therapy can be discontinued and whether or not treatment can be performed reliably without complications.