Evidence map›Paper›PMID 41068414›Full record

ArticleSurgical endoscopy2025

Evaluating the safety and efficacy of colorectal endoscopic submucosal dissection in elderly Western patients.

Salih N Karahan, Metincan Erkaya, Kamil Erozkan, Daniela Allende, Scott Steele, Michael Valente, Joshua Sommavilla, Emre Gorgun

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Salih N KarahanDepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Desk A-30, Cleveland, OH, 44195, USA.
Metincan ErkayaDepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Desk A-30, Cleveland, OH, 44195, USA.
Kamil ErozkanDepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Desk A-30, Cleveland, OH, 44195, USA.
Daniela AllendeDepartment of Pathology, Cleveland Clinic, Cleveland, OH, USA.
Scott SteeleDepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Desk A-30, Cleveland, OH, 44195, USA.
Michael ValenteDepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Desk A-30, Cleveland, OH, 44195, USA.
Joshua SommavillaDepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Desk A-30, Cleveland, OH, 44195, USA.
Emre GorgunDepartment of Colorectal Surgery, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Desk A-30, Cleveland, OH, 44195, USA. gorgune@ccf.org.ORCID http://orcid.org/0000-0001-7725-3522

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionEndoscopic submucosal dissection (ESD) has been increasingly preferred for the treatment of colorectal lesions. However, outcomes of colorectal ESD in elderly population remain debatable. Studies in Eastern populations showed that ESD offers comparable safety and efficacy between elderly and younger patients. Despite these findings and growing significance of the aging population, data from the Western population are lacking. The study investigates the safety and efficacy of colorectal ESD in patients aged 75 years or older. METHODS AND PROCEDURES: Elderly (≥ 75 years of age) and non-elderly (< 75 years of age) patients who underwent ESD between November 2011 and December 2023 were retrospectively compared in terms of patient demographics, lesion characteristics, perioperative and postoperative outcomes.

resultsIn this study, 149 (18.8%) elderly patients and 642 (81.2%) non-elderly patients underwent colorectal ESD. Two groups were comparable in terms of lesion localization, lesion type and previous intervention of the lesion. Elderly patients had a higher proportion of males (64% vs 52%, p = 0.01), higher ASA ≥ 3 scores (54% vs 36%, p < 0.01) and lower BMI (26.6 vs 29, p < 0.01). Median lesion size was higher in the elderly group (34 mm vs 30 mm, p = 0.02). Conversion to surgery (9.4% vs 4.2%, p = 0.01), postoperative bleeding (8.1% vs 3.7%, p = 0.03) were more frequent in the elderly group. Perforation rates and complications requiring postoperative intervention (3.74% vs 1.5%, p = 0.08) were similar. Multivariate analysis revealed that age ≥ 75 years was an independent risk factor for non-en-bloc resection (OR = 0.52, 95% CI [0.3-0.8]) and postoperative bleeding (OR = 2.63, 95% CI [1.3-5.3]). Elderly patients had a lower endoscopic follow-up rate (34.2% vs 46.3%, p < 0.01) and shorter median endoscopic follow-up duration (9.29 vs 25.17 months, p < 0.01).

conclusionIn contrast to studies from Asian populations, colorectal ESD in Western patients ≥ 75 years of age shows higher rates of non-en-bloc resection and postoperative bleeding. However, this may be influenced by selection bias, as colorectal surgeons in our center take a more aggressive approach, attempting ESD in more complex lesions. Despite these increased risks, overall complication rates remain low, suggesting that ESD remains a safe and feasible option for elderly patients when performed in experienced centers.

Indexed as

Colorectal NeoplasmsEndoscopic Mucosal ResectionAgedAged, 80 and overAge FactorsFemaleHumansMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesTreatment OutcomeColorectal ESDElderlyPostoperative complications

Identifiers

PMID41068414

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.