Risk of Colorectal Endoscopic Submucosal Dissection in Older Adults: A Nationwide Study in Japan

To evaluate the risks of colorectal endoscopic submucosal dissection (ESD) in older adult patients, given the increasing number of ESD in an aging population.

We conducted a retrospective cohort study using the Japanese nationwide database from 2012 to 2023. Patients aged 60 years or older who underwent colorectal ESD were included. The primary outcome was overall adverse events (AEs), including in-hospital mortality, procedure-related perforation, abdominal surgery, aspiration pneumonia, and significant postoperative bleeding and thromboembolic events. We first examined the association between age and AEs using multivariable regression adjusting for patient characteristics. Next, to explore the factors associated with overall AEs in those aged 85 years or older, we fit a multivariable logistic regression.

The study included 143,925 cases. Age distribution was as follows: 60-64 (13.5%), 65-74 (44.9%), 75-84 (35.8%), and ≥85 (5.8%) years. The prevalence of overall AEs increased with age: 5.3% for ages 60-64 years, 7.9% for ages 85-89 years, and 9.2% for ages 90 years or older. Patients aged 85 years or older had a higher prevalence of overall AEs compared with patients aged 60-64 years, with an adjusted odds ratio of 1.19 (95% confidence interval: 1.07-1.33, P < 0.01) for those aged 85-89 years and an adjusted odds ratio of 1.45 (95% confidence interval: 1.16-1.80, P < 0.01) for those aged 90 years or older. Most AEs in patients aged 85 years or older were due to significant postoperative bleeding, with anticoagulant use and body mass index ≥30 identified as key risk factors.

The risks of AEs during colorectal ESD increase with age, particularly in patients aged 85 years or older.