Safety of esophageal EMR in elderly patients

• Published in: Gastrointestinal endoscopy Vol. 80; no. 4; pp. 586 - 591
• Main Authors: Qumseya, Bashar, MD, MPH, David, Waseem, MD, Woodward, Timothy A., MD, Raimondo, Massimo, MD, Wallace, Michael B., MD, MPH, Wolfsen, Herbert C., MD, Lukens, Frank J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2014
• Subjects: Age Factors; Aged; Aged, 80 and over; Barrett Esophagus - pathology; Barrett Esophagus - surgery; Cohort Studies; Esophagoscopy - methods; Female; Follow-Up Studies; Gastroenterology and Hepatology; Humans; Logistic Models; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Mucous Membrane - surgery; Multivariate Analysis; Patient Safety; Retrospective Studies; Risk Assessment; Tertiary Care Centers; Treatment Outcome; BE; HGD; Barrett's esophagus; ESD; endoscopic submucosal dissection; high-grade dysplasia; RFA; radiofrequency ablation
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2014.02.010

Background EMR is commonly used to remove suspicious esophageal lesions among patients with Barrett's esophagus (BE). BE primarily affects older patients. Yet, the safety profile of EMR in elderly patients has not been well-described. Objective We aimed to study the safety profile of EMR in elderly patients compared with younger patients. Design Retrospective, observational, descriptive study that used a prospective database. Setting Tertiary-care referral center. Patients A total of 136 patients who underwent esophageal EMR for BE. Interventions EMR with/without ablative therapy. Main Outcome Measurements The rate of adverse events, including bleeding, stricture formation, and perforation between elderly (aged ≥75 years) and younger (aged <75 years) patients. Results We identified 136 patients who underwent esophageal EMR who were followed-up in our clinic. Of those, 40% (n = 55) were aged ≥75 years (elderly group) and 60% (n = 81) were aged <75 years (younger group). There was no difference in rate of stricture formation or early or delayed bleeding when we compared elderly patients to younger patients. None of the patients had esophageal perforation. On multivariable logistic regression analysis, controlling for patient sex, EMR technique, and underlying pathology, older age was not associated with increased odds of adverse events (OR 0.88; 95% confidence interval, 0.42-1.9; P  = .75). Limitations Single-center experience. Conclusion Rates of adverse events from EMR appear to be similar in elderly patients compared with younger patients. Overall, esophageal EMR seems to offer an acceptable safety profile in elderly patients.