Upper Gastrointestinal Endoscopy in Elderly Patients: An Individualized Decision-Making Approach for Screening and...

Population aging has led to a growing number of elderly individuals undergoing upper gastrointestinal (UGI) endoscopy for screening and surveillance. Although UGI endoscopic screening has been shown to reduce gastric and esophageal cancer mortality in high-risk regions, evidence specific to very elderly populations (≥ 80 years) remains limited. This review summarizes current epidemiologic data, risk stratification approaches, procedural considerations, examination quality, surveillance strategies, and future directions for UGI endoscopy in elderly patients, with particular emphasis on individuals aged ≥ 80 years. We highlight the importance of individualized decision-making that incorporates oncologic risk, frailty, comorbidity burden, life expectancy, procedural burden, and patient preferences. Quality-enhancing and burden-reducing strategies, including image-enhanced endoscopy and transnasal endoscopy, may help optimize the benefit-harm balance when endoscopy is considered appropriate. As global populations continue to age, generating high-quality evidence tailored to very elderly individuals will be essential to optimize the benefits and minimize the risks of UGI endoscopy.