Clinical Impact and Tolerance of Unsedated Esophagogastroduodenoscopy in Patients Aged ≥75 Years

Purpose Esophagogastroduodenoscopy (EGD) is widely used in older adults, but concerns persist about tolerance when performed without anesthesia, especially in very old and frail inpatients. We aimed to assess the diagnostic yield, impact on management, and tolerance of unsedated EGD in hospitalized patients aged ≥75 years. Methods We conducted a retrospective, single-center study including all inpatients aged ≥75 years who underwent EGD without general anesthesia or systemic sedation between January 2018 and December 2019. The primary endpoint was the presence of a macroscopic lesion consistent with the indication. Secondary endpoints were the contribution of EGD to diagnostic and therapeutic management and endoscopist-rated tolerance (good, intermediate, poor). Results Two hundred patients were included (mean age, 86.8 ± 5.8 years; 53% women; 85% malnourished). A macroscopic lesion consistent with the indication was found in 44% of cases. Overall, EGD was contributory in 83.5% of patients, including 70.5% of those without macroscopic lesions, mainly through treatment changes or additional investigations. The completion rate was 83.5%. Tolerance was rated as good in 46.5%, intermediate in 17.5% and poor in 29.5%. In multivariable analysis, a lower Mini-Mental State Examination score and severe malnutrition remained associated with poor tolerance. Conclusion In very old inpatients, unsedated EGD remains highly contributory, even when no macroscopic lesion is observed. Simple clinical factors can help anticipate tolerance and support selective, individualized decision-making regarding EGD in geriatric practice.