Impact of Sarcopenia on Elderly Patients Undergoing Endoscopic Resection: Scoping Review

Sarcopenia is a recognized risk factor in surgical oncology, yet its clinical significance in patients undergoing endoscopic resection (ER) remains controversial. This scoping review investigated the prevalence of sarcopenia and its association with technical outcomes, systemic complications, and long-term prognosis in patients undergoing ER.

We followed the PRISMA-ScR framework and searched MEDLINE, Cochrane Central, Web of Science, and Ichushi Web up to November 12, 2025. Eligible studies involved patients undergoing ER (endoscopic submucosal dissection or endoscopic mucosal resection) for esophageal, gastric, or colorectal neoplasms, regardless of diagnostic criteria. A narrative synthesis was performed.

Twenty-eight studies, predominantly retrospective cohorts from East Asia, were included. Prevalence ranged from 13.9% to 72.7%. Most studies defined sarcopenia by skeletal muscle mass on computed tomography; only one prospective study incorporated muscle strength. Sarcopenia was generally not associated with technical outcomes such as en bloc resection or perforation. However, it was associated with systemic complications: post-procedural pneumonia was more frequent in two of three studies (odds ratio 3.16 in one), moderate-to-severe adverse events (CTCAE ≥ 2) in three of four, and hospital stay was prolonged in all three reporting studies. Sarcopenia was also associated with poor overall survival (hazard ratios 1.7-15.0), driven by non-disease-specific mortality.

Sarcopenia does not compromise the technical safety of ER but is a critical marker for systemic complications and poor prognosis. Current evidence is limited by retrospective designs lacking muscle strength data. Future research should prioritize prospective assessment using multifaceted diagnostic criteria to refine risk stratification.