First Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan.
Dig Dis. 2021;39(5):435-443. doi: 10.1159/000514275. Epub 2021 Jan 11.
Endoscopic submucosal dissection (ESD) is an effective treatment for gastric neoplasms in elderly patients; however, it involves several adverse events, including pneumonia. This study aimed to investigate whether skeletal muscle depletion (SMD) was associated with the development of pneumonia in elderly patients who underwent gastric ESD.
This retrospective observational cohort study included 157 patients (≥80 years) who had undergone gastric ESD. The skeletal muscle cross-sectional area was measured by CT, and the value of the third lumbar vertebra skeletal muscle index (L3 SMI) was evaluated. The SMD was defined as an L3 SMI value ≤38.0 cm2/m2 for women and ≤42.0 cm2/m2 for men. Pneumonia was also diagnosed using CT to identify all included patients.
Among 157 patients, 66 (42.0%) showed SMD. In the SMD group, the incidence of pneumonia was 21.2%, whereas it was 7.7% in the non-SMD group (p = 0.018). The longest hospitalization duration was 19 days. Antibiotics were administered in 61.9% of the patients. Procedure time was not significantly different between the groups (72 ± 54 min vs. 62 ± 44 min, p = 0.201). On multivariate analysis, SMD was an independent risk factor for the development of pneumonia (odds ratio = 3.16, 95% confidence interval, 1.18-8.50, p = 0.023).
SMD was not a rare entity in patients aged ≥80 years with gastric neoplasms. SMD was a significant risk factor for pneumonia related to gastric ESD in elderly patients.
内镜黏膜下剥离术（ESD）是治疗老年患者胃肿瘤的有效方法，但它涉及多种不良事件，包括肺炎。本研究旨在探讨在接受胃 ESD 的老年患者中，骨骼肌减少症（SMD）是否与肺炎的发生有关。
本回顾性观察性队列研究纳入了 157 名（≥80 岁）接受胃 ESD 的患者。通过 CT 测量骨骼肌的横截面积，并评估第三腰椎骨骼肌指数（L3 SMI）值。SMD 定义为女性 L3 SMI 值≤38.0cm2/m2，男性 L3 SMI 值≤42.0cm2/m2。肺炎也通过 CT 诊断，以确定所有纳入患者。
在 157 名患者中，有 66 名（42.0%）出现 SMD。在 SMD 组中，肺炎的发生率为 21.2%，而非 SMD 组为 7.7%（p=0.018）。最长住院时间为 19 天。61.9%的患者使用了抗生素。两组之间的手术时间无显著差异（72±54min 与 62±44min，p=0.201）。多变量分析显示，SMD 是肺炎发生的独立危险因素（比值比=3.16，95%置信区间，1.18-8.50，p=0.023）。
在患有胃肿瘤的≥80 岁老年患者中，SMD 并不罕见。SMD 是老年患者胃 ESD 相关肺炎的显著危险因素。
