Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

Abstract

With the ongoing increase in the aging population in Japan, the number of elderly patients among the total population with upper gastrointestinal (GI) neoplasia has also been increasing. As elderly patients present unique age‐related variations in their physical condition, the therapeutic approach for upper GI neoplasia should be differentiated between elderly and nonelderly patients. According to the existing guidelines, additional treatment is the standard therapy in patients who undergo endoscopic resection (ER) with a possible risk of lymph node metastasis (LNM) for upper GI neoplasia. However, due to the relatively low rate of LNM, applying additional treatment in all elderly patients may be excessive. Although additional treatment has the advantage of reducing cancer‐specific mortality, its disadvantages include deteriorated quality of life, complications, and mortality in surgery. In patients with early gastric cancer, we propose treatment decisions be made using a risk‐scoring system for LNM and upon considering the physical condition of the patient after ER with curability C‐2. In those with superficial esophageal squamous cell carcinoma with a possible risk of LNM after ER, selective chemoradiotherapy may be a less‐invasive treatment option, although the present standard treatment is esophagectomy. When considering the treatment decision, achieving a “cure” of the tumor has been regarded as critical. However, as the main cause of mortality in elderly patients with ER for upper GI neoplasia is noncancer‐related death, both achieving a “cure” and also a good level of “care” is important in the management of elderly patients.

Predictors of Early and Late Mortality after Endoscopic Resection for Esophageal Squamous Cell Carcinoma

“…To date, many reports have investigated LNM or ESCC-related mortality (Choi et al 2011;Yamashina et al 2013). Moreover, regarding cases with ER for gastric cancer, several studies have focused on all-cause mortality as well as gastric cancer-related mortality (Hatta et al 2020). However, few studies focused on all-cause mortality in patients undergoing ER for ESCC.…”

A Novel Bipolar Polypectomy Snare Can Be an Alternative Choice for Endoscopic Resection

“…Colorectal polyp ER is a form of minimally invasive surgery and is widely used (6). Almost all complications of ER with monopolar snares have been previously reported (20)(21)(22).…”

“…Therapeutic colonoscopy, including colon polypectomy and endoscopic mucosal resection (EMR), has recently been widely performed as an effective and less invasive treatment strategy (5,6). This treatment, called "day surgery, " can be performed without hospitalization.…”

Comparison of Magnifying Endoscopy with Blue Light Imaging and Narrow Band Imaging for Determining the Invasion Depth of Superficial Esophageal Squamous Cell Carcinoma by the Japanese Esophageal Society’s Intrapapillary Capillary Loop Classification

“…Esophageal cancer is the seventh leading cause of the cancer incidence and the sixth leading cause of cancer death [1], and esophageal squamous cell carcinoma accounts for 84% of cases with esophageal cancers [2,3]. Endoscopic resection (ER) is a minimally invasive treatment method for superficial esophageal squamous cell carcinoma (SESCC) without lymph node metastasis [4], and favorable long-term outcomes have been reported [5][6][7]. According to the latest Japanese guidelines [8], ER is recommended for tumors confined to the epithelium or lamina propria mucosa (cT1a-EP/LPM) or those invading into the muscularis mucosa or submucosa ≤200 µm (cT1a-MM/T1b-SM1) when the tumors are not circumferential.…”