The Safety and Efficacy of Colorectal Endoscopic Submucosal Dissection in the Elderly: A Large Western Analysis of 710 Lesions.

Background and study aims: Colorectal endoscopic submucosal dissection (ESD) is increasingly used for the management of laterally spreading colorectal lesions in the West. With increasing life expectancy and prevalence of colorectal neoplasia, ESD is frequently performed in the elderly. 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. We investigated the safety and outcomes of colorectal ESD in a large Western cohort.

Patients and methods: We retrospectively analyzed 710 colorectal lesions undergoing ESD at a tertiary medical center from July 2015 to November 2024. Patients were divided into 3 age groups: under 65 years (n=342), 65 to 75 years (n=272), and older than 75 years (n=96). Outcomes included en-bloc and R0 resection rates, procedural and postprocedural adverse events, and length of stay.

Results: En-bloc resection rates (87.4%, 80.9%, and 80.2%) and R0 resection rates (69.6%, 68%, and 61.5%) were comparable across the <65, 65 to 75, and ≥75 groups, respectively. Despite higher comorbidities and use of antithrombotics/anticoagulants in the elderly group, overall postprocedure adverse event rates were low and with no significant difference among groups (6.7%, 8.5%, and 6.3%) (P=0.651). A higher length of stay in the ≥75 group was noted compared with the <65, 65 to 75, respectively (1.1 d, vs. 0.6 and 0.5, P<0.001).

Conclusions: Colorectal ESD in Western elderly patients by expert endoscopists is safe and effective, with outcomes comparable to younger cohorts. This study supports ESD as a feasible option for managing colorectal neoplasms in an aging population.