Sferrazza Sandro, Calabrese Giulio, Maida Marcello, Capogreco Antonio, de Sire Roberto, Cecinato Paolo, Sassatelli Romano, De Roberto Giuseppe, Barbaro Federico, Spada Cristiano, Chiappetta Michele Francesco, Pugliese Francesco, Cutolo Francesco, Manno Mauro, Soriani Paola, Rosa Rizzotto Erik, Gubbiotti Alessandro, Andrisani Gianluca, Di Matteo Francesco, Azzolini Francesco, Repici Alessandro, Di Mitri Roberto, Maselli Roberta
Gastroenterology and Endoscopy Unit, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy.
Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Endosc Int Open. 2025 May 12;13:a25681366. doi: 10.1055/a-2568-1366. eCollection 2025.
Endoscopic submucosal dissection (ESD) has emerged as the standard treatment for colorectal lesions. Considering aging of the global population, we aimed to assess effectiveness and safety of colorectal ESD in patients aged ≥ 80 years compared with those aged 65 to 79 years in a large Western cohort.
We retrospectively enrolled patients aged > 64 years undergoing colorectal ESD, classifying them into a very elderly group (VE-Group, aged > 80 years) and elderly group (E-Group, 65-79 years). Procedure outcomes and safety were compared between the VE-Group and E-Group and between patients with comorbidities and those who were healthy (1-CM-Group and H-Group).
A total of 980 patients were included (269; 27.5% in the VE-Group and 711; 72.5% in the E-Group). En-bloc, R0, and oncological curative resection rates did not differ, nor did intra-procedure or post-procedure adverse events (AEs). Delirium occurrence was registered in VE-group [6 (2.2%) in VE-Group vs 1 (0.1%) in E-Group; = 0.001; OR = 16.2, (95%CI:1.9-135.2)]. The 1-CM-Group had a higher rate of intra-procedure bleeding ( = 0.001), delayed perforation ( = 0.03), fever onset ( < 0.001), and systemic infections ( = 0.02) compared with the H-Group. Having one or more comorbidities was associated with increased overall AEs ( < 0.001; OR 2.3, 95% CI 1.5-3.6).
Colorectal ESD is feasible in elderly patients. Physicians should consider delirium a possible AE in patients older than age 80 years. These findings, which bridge the gap between Asian and Western clinical data, underscore the importance of tailored pre-procedure and post-procedure assessments in a global clinical context.
内镜黏膜下剥离术（ESD）已成为结直肠病变的标准治疗方法。考虑到全球人口老龄化，我们旨在评估在一个大型西方队列中，年龄≥80岁的患者与65至79岁的患者相比，结直肠ESD的有效性和安全性。
我们回顾性纳入了年龄>64岁接受结直肠ESD的患者，将他们分为高龄组（VE组，年龄>80岁）和老年组（E组，65 - 79岁）。比较了VE组和E组之间以及有合并症患者和健康患者（1-CM组和H组）之间的手术结果和安全性。
共纳入980例患者（269例；VE组占27.5%，711例；E组占72.5%）。整块切除率、R0切除率和肿瘤根治性切除率无差异，术中或术后不良事件（AE）也无差异。VE组出现了谵妄[VE组6例（2.2%），E组1例（0.1%）；P = 0.001；OR = 16.2，（95%CI：1.9 - 135.2）]。与H组相比，1-CM组术中出血率更高（P = 0.001）、延迟穿孔率更高（P = 0.03）、发热发生率更高（P < 0.001）以及全身感染率更高（P = 0.02）。有一项或多项合并症与总体AE增加相关（P < 0.001；OR 2.3，95%CI 1.5 - 3.6）。
结直肠ESD在老年患者中是可行的。医生应将谵妄视为80岁以上患者可能出现的不良事件。这些填补了亚洲和西方临床数据之间差距的研究结果，强调了在全球临床背景下进行个性化术前和术后评估的重要性。
