Efficacy and safety of endoscopic submucosal dissection for gastric epithelial neoplasia in elderly patients aged 80 years and older

Son, Young Woong; Kim, Ain; Jeon, Han Ho

doi:10.1007/s40520-019-01133-6

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…23 articles were screened by their full-texts and six (15)(16)(17)(18)(19)(20) were excluded with reasons (Table 1). Finally, 17 cohort studies were found to be eligible for inclusion in this review (4,(10)(11)(12)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

Section: Resultsmentioning

confidence: 99%

“…The review was also unable to differentiate outcomes based on various definitions of elderly (≥65 years, ≥75 years, or ≥80 years). Further, with the publication of several recent studies (10)(11)(12), there is a need for updated evidence on the applicability and safety of ESD in elderly patients. In this context, the current study was designed to compare resection rates, complication rates, and length of hospital stay between elderly and non-elderly patients undergoing ESD for early gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly vs. Non-Elderly Patients: A Systematic Review and Meta-Analysis

et al. 2022

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ObjectiveThis study aimed to review the applicability and complications rate associated with endoscopic submucosal dissection (ESD) for early gastric cancer in elderly patients.MethodsDatabases of PubMed, Embase, CENTRAL, and ScienceDirect were searched till 15th April 2021. All types of studies comparing ESD in the elderly vs non-elderly were included. Subgroup analysis was conducted for the following groups: ≥80 years vs <80 years, ≥75 years vs < 75 years, and ≥65 years vs <65 years.Results17 studies were included. Meta-analysis indicated no statistically significant difference in the en-bloc resection rates (OR: 0.92 95% CI: 0.68, 1.26 I2 = 8% p=0.62) and histological complete resection rates (OR: 0.93 95% CI: 0.75, 1.15 I2 = 26% p=0.50) between elderly and non-elderly patients. The results were non-significant even on subgroup analysis. Overall, we found a non-significant but a tendency of increased perforation rates in the elderly as compared to non-elderly patients (OR: 1.22 95% CI: 0.99, 1.52 I2 = 0% p=0.06). However, there was a significantly increased risk of perforation in elderly patients aged ≥80 years as compared to patients <80 years (OR: 1.50 95% CI: 1.00, 2.24 I2 = 3% p=0.05). Bleeding rates were not different in the two groups (OR: 1.07 95% CI: 0.87, 1.32 I2 = 19% p=0.52). Pooled analysis indicated a statistically significantly increased risk of pneumonia in elderly patients (OR: 2.52 95% CI: 1.72, 3.70 I2 = 7% p<0.00001). Length of hospital stay was reported only by five studies. Meta-analysis indicated no significant difference between the two study groups (MD: 0.67 95% CI: -0.14, 1.48 I2 = 83% p=0.10).ConclusionEn-bloc and histological complete resection rates do not differ between elderly and non-elderly patients undergoing ESD for early gastric cancer. Elderly patients have a small tendency of increased risk of perforation with significantly increased rates in the super-elderly (≥80 years of age). The risk of pneumonia is significantly higher in elderly patients but the rates of bleeding do not differ. The certainty of evidence is “very low” and there is a need for high-quality studies taking into account confounding factors to enhance the quality of evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly vs. Non-Elderly Patients: A Systematic Review and Meta-Analysis

et al. 2022

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“…We recommend semiannual gastroscopic biopsy reexaminations for patients with low-grade epithelial neoplasia and suggest endoscopic submucosal dissection (ESD) for lesion resection once aggravated morphological changes are observed. Current treatment strategies for high-grade intraepithelial neoplasia include endoscopic therapy, surgical treatment, and follow-up [23]. In the present study, 12 patients were with high-grade neoplasia of epithelial cells.…”

Section: Discussionmentioning

confidence: 80%

Histomorphological Characteristics and Pathological Types of Hyperproliferation of Gastric Surface Epithelial Cells

Wang

Shen

Zhao

et al. 2021

Gastroenterology Research and Practice

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Objective. To investigate the histomorphological characteristics and pathological types of hyperproliferation of gastric surface epithelial cells. Methods. Hematoxylin and Eosin, Periodic acid–Schiff, and immunohistochemical staining were performed on biopsy specimens obtained from 723 patients with hyperproliferation of gastric surface epithelial cells and/or hyperplasia of gastric pits. Follow-up gastroscopic reexaminations were performed on 475 patients included. Improvement probability was analyzed using Kaplan-Meyer as well as Cox proportional hazards models. Results. Seven different histomorphologies and clinicopathologies of hyperproliferation of gastric surface epithelial cells were identified: (1) common hyperplasia of gastric epithelial cells, which was characterized by focal glandular epithelial hyperplasia of gastric pits with chronic inflammation; (2) drug-induced hyperplasia of gastric epithelial cells, which was characterized by increased hyperplasia of gastric pits and cells arranged in a monolayer; (3) Helicobacter pylori (Hp) infection-induced hyperplasia of gastric epithelial cells, which was characterized by the disappearance of oval, spherical, and bounded membrane-enclosed mucus-containing granules in the cytoplasm and on the nucleus together with cytoplasmic swelling and vacuolation; (4) metaplastic hyperplasia of gastric epithelial cells, which was characterized by the coexistence of intestinal metaplastic cells with hyperplastic gastric epithelial cells; (5) atrophic hyperplasia of gastric epithelial cells, which was characterized by the mucosal atrophy accompanied with hyperplasia of gastric pits; (6) low-grade neoplasia of epithelial cells, which was characterized by the mild to moderate dysplasia of gastric epithelial cells; and (7) high-grade neoplasia of epithelial cells, which was characterized by the evident dysplasia of hyperplastic epithelial cells and losses of cell polarity. The different pathological types are associated with different improvement probabilities. Conclusions. This study demonstrated the histomorphological characteristics and pathological types, which might guide clinicians to track malignant cell transformation, perform precise treatment, predict the clinical prognosis, and control the development of gastric cancer.

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“…Since many EGCs are found among very elderly patients, the chance of undergoing ESD for EGC is high in this population. Several studies have reported the outcomes of ESD for EGC in elderly patients aged ≥75 years [ 4 , 5 , 6 ] or ≥80 years [ 7 , 8 , 9 , 10 ]. However, few studies have reported ESD for EGC in patients aged ≥85 years [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years

Yoshikawa

Yamauchi

Hamasaki

et al. 2022

Cancers

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Endoscopic submucosal dissection (ESD) is a safe and minimally invasive method for the treatment of early gastric cancer (EGC). However, whether ESD for EGC is also safe and feasible in patients aged ≥ 85 years is unclear. The patients enrolled in this study were divided into three groups: age ≥ 85 years (44 patients, 49 lesions), age 65–84 years (624 patients, 687 lesions), and age ≤ 64 years (162 patients, 174 lesions). We evaluated the incidence of adverse events (AEs) and overall survival (OS) and disease-specific survival (DSS). We analyzed the factors that had a significant impact on the prognosis of patients aged ≥ 85 years. No significant differences were found in the incidence of AEs among the three groups (p = 0.612). The OS was significantly lower in patients aged ≥ 85 years (p < 0.001). Conversely, DSS was not significantly worse in patients aged ≥ 85 years (p = 0.100). The poor Geriatric Nutritional Risk Index correlated with poor prognosis in patients aged ≥ 85 years (p < 0.001). ESD is a safe and valid treatment for EGC in patients aged ≥ 85 years. However, the indications should be carefully decided because it is difficult to estimate the survival contribution of ESD for EGC in patients aged ≥ 85 years, especially in those with poor nutritional status.

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Efficacy and safety of endoscopic submucosal dissection for gastric epithelial neoplasia in elderly patients aged 80 years and older

Cited by 9 publications

References 22 publications

Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly vs. Non-Elderly Patients: A Systematic Review and Meta-Analysis

Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly vs. Non-Elderly Patients: A Systematic Review and Meta-Analysis

Histomorphological Characteristics and Pathological Types of Hyperproliferation of Gastric Surface Epithelial Cells

The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years

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