Is colorectal endoscopic submucosal dissection safe in elderly patients?

Colorectal endoscopic submucosal dissection (ESD) performed by expert endoscopists in Western older adults is safe and effective, according to a study. Outcomes are also similar to those in younger cohorts.

“With increasing life expectancy and prevalence of colorectal neoplasia, ESD is frequently performed in the elderly,” the researchers said. “While ESD has been shown to be safe in elderly Eastern populations, there are key differences in endoscopist, patient, and lesion characteristics in the West.”

The research team retrospectively analysed 710 colorectal lesions undergoing ESD at a tertiary medical centre from July 2015 to November 2024. They divided patients into three age groups: under 65 years (n=342), 65‒75 years (n=272), and older than 75 years (n=96). Outcomes assessed were en-block and R0 resection rates, procedural and post-procedural adverse events (AEs), and length of stay.

The rates of en-bloc (87.4 percent, 80.9 percent, and 80.2 percent, respectively) and R0 resection (69.6 percent, 68 percent, and 61.5 percent, respectively) did not significantly differ across age groups.

Notably, the elderly group had more comorbidities and greater use of antithrombotics or anticoagulants, but their overall post-procedural AE rates were low, with no significant differences across age groups (6.7 percent vs 8.5 percent vs 6.3 percent; p=0.651). However, elderly patients had a longer length of stay than those aged <65 and 65‒75 years (1.1 vs 0.6 and 0.5 days; p<0.001).

“This study supports ESD as a feasible option for managing colorectal neoplasms in an ageing population,” the researchers said.