Aims
The evidence guiding the use of Endoscopic mucosal resection (EMR) in elderly and very elderly patients remains limited. It’s known that the Mediterranean diet (MD) has healthy properties, and Cilento is an area in southern Italy, considered the cradle of the MD, with a high number of long-living individuals.
The primary outcome was to evaluate the safety and efficacy of EMR in these patients. Furthermore, we aimed to identify specific variables correlated with age to contribute to a more tailored approach in this growing patient group, particularly in our geographic area.
Methods
We conducted a multicenter retrospective study analyzing 402 patients undergoing EMR for colorectal lesions ≥10 mm between January 2020 and April 2025. Patients were stratified into age groups: <65 vs ≥65 years, and <80 vs ≥80 years. Demographics, polyp characteristics, technical outcomes, histology, and adverse events were compared between groups. A subanalysis was performed to evaluate the outcomes for lesions ≥20 mm. Correlation analyses explored the associations between clinical, procedural, and histological variables.
Results
EMR achieved high technical success across all age groups, with complication rates of 2.4% in patients <65 years and 4.8% in those ≥65 years, and no perforations in any group. In patients aged 80 years or older, the prevalence of adenocarcinoma was significantly higher (10% vs. 3.6%, p = 0.043), and a moderate correlation was observed between lesion size and high-grade dysplasia/adenocarcinoma (r = 0.64). Younger patients more frequently underwent en bloc resection, while elderly patients presented with more complex lesions. Follow-up rates remained low across groups.
|
|
Age < 65 y (n = 145) |
Age ≥ 65 y (n= 257) |
P value |
Age < 80 y (n = 344) |
Age ≥ 80 y (n= 58) |
P value |
|
Women |
59 (40,7%) |
85 (33,1%) |
0.115 |
125 (36,3%) |
18 (31,0%) |
0.527 |
|
Mean age, y (Standard deviation) |
55,7 (7,3)
|
74,2 (6,4) |
< 0.001* |
64,9 (9,7) |
83,3 (3) |
< 0.001* |
|
Number of polyps |
167 |
305 |
|
402 |
70 |
|
|
Location of polyps |
|
|
0.983 |
|
|
0.958 |
|
Rectus |
16 (9,6%) |
28 (9,2%) |
1.000 |
36 (9%) |
8 (11,4%) |
0.601 |
|
Sigma |
62 (37,1%) |
112 (36,8%) |
0.956 |
146 (36,3%) |
28 (40%) |
0.493 |
|
Descending |
18 (10,8%) |
32 (10,5%) |
1.000 |
43 (10,7%) |
7 (10%) |
1.000 |
|
Transverse |
19 (11,4%) |
34 (11,2%) |
1.000 |
46 (11,4%) |
7 (10%) |
0.951 |
|
Ascending |
35 (21%) |
72 (23,7%) |
0.467 |
93 (23,13%) |
14 (20%) |
0.763 |
|
Cecum |
17 (10,2%) |
26 (8,6%) |
0.739 |
38 (9,5%) |
6 (8,6%) |
1.000 |
|
Pathology of polyps |
|
|
0.195 |
|
|
0.076 |
|
Hyperplastic |
27 (17,9%) |
31 (11,5%) |
0.077 |
20 (6,1%) |
7 (11,7%) |
0.160 |
|
Serrated |
4 (2,6%) |
11 (4,1%) |
0.588 |
14 (4,0%) |
1 (1,6%) |
0.484 |
|
Adenomatous |
115 (76,16%) |
215 (79,6%) |
0.459 |
284 (86,1%) |
46 (76,7%) |
0.079 |
|
Adenocarcinoma |
5 (3,3%) |
13 (4,8%) |
0.617 |
12 (3,6%) |
6 (10%) |
0.043 * |
|
Patients with follow-up examination |
11 (7,6%) |
23 (8,9%) |
0.763 |
24 (7,1%) |
3 (5,2%) |
0.794 |
Conclusions
EMR is a safe and effective technique for removing colorectal polyps in elderly and very elderly patients, with complication rates and efficacy comparable to those in younger cohorts. Age alone should not preclude EMR. A comprehensive patient-centred assessment, including lesion characteristics, comorbidities, and life expectancy, optimises outcomes. Vigilant surveillance is recommended for elderly and very elderly patients, particularly for large lesions due to their higher malignant potential.