P4192 - Safety and Efficacy of Endoscopic Submucosal Dissection for Early Gastric Cancer Among Elderly Population: A Systematic Review and Meta-Analysis

Umar Hayat, MD¹, Saba Afroz, MD¹, Hassam Ali, MD², Aamir Saeed, MD³, Iqra Arshad, MD, MPH⁴, Faisal Kamal, MD⁵, Anila Mahesh, MD¹, Wajeeh hassan, MBBS⁶, Danial H.. Shaikh, MD⁷, Ali Siddiqui, MD⁸, Aman Ali, MD⁹, Douglas G. Adler, MD, FACG¹⁰
1Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; 2East Carolina University/Brody School of Medicine, Greenville, NC; 3Vanderbilt University Medical Center, Nashville, TN; 4SSM Health Saint Louis University Hospital, Saint Louis, MO; 5Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; 6Allama Iqbal Medical College, Lahore, Lahore, Punjab, Pakistan; 7Geisinger Health System, Danville, PA; 8Maimonides Medical Center, Fairfax, VA; 9Wilkes-Barre General Hospital, Scranton, PA; 10Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: Gastric cancer is the second leading cause of cancer-related death worldwide. While its incidence in younger populations has declined due to a reduction in H. pylori infections, it remains high among older adults in certain regions. Timely intervention for early gastric cancer (EGC) correlates with better prognosis. Endoscopic submucosal dissection (ESD) is widely accepted as a treatment for early gastric cancer (EGC) lesions. Most EGC patients are elderly with comorbidities, making ESD challenging and potentially risky. This study evaluates the safety and efficacy of ESD for managing early gastric cancer in elderly patients (aged ≥75 years).

Methods: A comprehensive literature search was conducted across multiple databases, encompassing both retrospective and prospective studies, to assess the safety and efficacy of ESD for EGC in elderly individuals from inception to October 1, 2024. The key outcomes assessed included en bloc and R0 resection rates, as well as the incidence of adverse events, such as periprocedural bleeding, perforation, and post-procedural pneumonia. Data were analyzed using a random-effects model, and subgroup analyses were conducted to ascertain all study outcomes.

Results: A total of 10 studies met the inclusion criteria, involving 2,020 patients and 2,102 lesions. All the included patients were aged 75 years or older and had undergone ESD for EGC. The pooled en bloc and R0 resection rates of ESD were 96.23% (95% CI: 93.62, 98.22) and 86.48% (95% CI: 79.59, 92.17), respectively, establishing it as an effective treatment option for EGC among the elderly—Figure 1. Furthermore, the rates of periprocedural bleeding and perforation were 5.4% (95% CI: 2.84, 8.74) and 3.23% (95% CI: 2.47, 4.07), respectively. Finally, the occurrence rate of post-procedural pneumonia was 2.56% (95% CI: 1.51, 3.85)—Figure 2.

Discussion: This comprehensive study demonstrated that Endoscopic Submucosal Dissection (ESD) is not only a safe but also an effective procedure for treating Early Gastric Cancer (EGC) in elderly patients. Notably, this finding holds even in the presence of multiple comorbidities that are often observed in this particular age group. Given the significance of these results, future prospective studies need to widen their scope and investigate additional outcomes.


Figure: En bloc and R0 resection rate of ESD


Figure: Post-ESD complications

Disclosures:
Umar Hayat indicated no relevant financial relationships.
Saba Afroz indicated no relevant financial relationships.
Hassam Ali indicated no relevant financial relationships.
Aamir Saeed indicated no relevant financial relationships.
Iqra Arshad indicated no relevant financial relationships.
Faisal Kamal indicated no relevant financial relationships.
Anila Mahesh indicated no relevant financial relationships.
Wajeeh hassan indicated no relevant financial relationships.
Danial Shaikh indicated no relevant financial relationships.
Ali Siddiqui indicated no relevant financial relationships.
Aman Ali indicated no relevant financial relationships.
Douglas Adler: Boston Scientific – Consultant.

Umar Hayat, MD¹, Saba Afroz, MD¹, Hassam Ali, MD², Aamir Saeed, MD³, Iqra Arshad, MD, MPH⁴, Faisal Kamal, MD⁵, Anila Mahesh, MD¹, Wajeeh hassan, MBBS⁶, Danial H.. Shaikh, MD⁷, Ali Siddiqui, MD⁸, Aman Ali, MD⁹, Douglas G. Adler, MD, FACG¹⁰. P4192 - Safety and Efficacy of Endoscopic Submucosal Dissection for Early Gastric Cancer Among Elderly Population: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.