Evaluating the safety and efficacy of colorectal endoscopic submucosal dissection in elderly Western patients

Endoscopic submucosal dissection (ESD) has been increasingly preferred for the treatment of colorectal lesions. However, outcomes of colorectal ESD in elderly population remain debatable. Studies in Eastern populations showed that ESD offers comparable safety and efficacy between elderly and younger patients. Despite these findings and growing significance of the aging population, data from the Western population are lacking. The study investigates the safety and efficacy of colorectal ESD in patients aged 75 years or older.

Elderly (≥ 75 years of age) and non-elderly (< 75 years of age) patients who underwent ESD between November 2011 and December 2023 were retrospectively compared in terms of patient demographics, lesion characteristics, perioperative and postoperative outcomes.

In this study, 149 (18.8%) elderly patients and 642 (81.2%) non-elderly patients underwent colorectal ESD. Two groups were comparable in terms of lesion localization, lesion type and previous intervention of the lesion. Elderly patients had a higher proportion of males (64% vs 52%, p = 0.01), higher ASA ≥ 3 scores (54% vs 36%, p < 0.01) and lower BMI (26.6 vs 29, p < 0.01). Median lesion size was higher in the elderly group (34 mm vs 30 mm, p = 0.02). Conversion to surgery (9.4% vs 4.2%, p = 0.01), postoperative bleeding (8.1% vs 3.7%, p = 0.03) were more frequent in the elderly group. Perforation rates and complications requiring postoperative intervention (3.74% vs 1.5%, p = 0.08) were similar. Multivariate analysis revealed that age ≥ 75 years was an independent risk factor for non-en-bloc resection (OR = 0.52, 95% CI [0.3-0.8]) and postoperative bleeding (OR = 2.63, 95% CI [1.3-5.3]). Elderly patients had a lower endoscopic follow-up rate (34.2% vs 46.3%, p < 0.01) and shorter median endoscopic follow-up duration (9.29 vs 25.17 months, p < 0.01).

In contrast to studies from Asian populations, colorectal ESD in Western patients ≥ 75 years of age shows higher rates of non-en-bloc resection and postoperative bleeding. However, this may be influenced by selection bias, as colorectal surgeons in our center take a more aggressive approach, attempting ESD in more complex lesions. Despite these increased risks, overall complication rates remain low, suggesting that ESD remains a safe and feasible option for elderly patients when performed in experienced centers.