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Original research
Outcomes and adverse factors for endoscopic mucosal resection (EMR) of colorectal polyps in elderly patients
  1. Thomas Skouras1,
  2. Ashley Bond1,
  3. Asimina Gaglia1,
  4. Laura Bonnett2,
  5. Meng Jiang Lim1,
  6. Sanchoy Sarkar1
  1. 1Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
  2. 2Department of Biostatistics, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Sanchoy Sarkar, Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool L78XP, UK; Sanchoy.Sarkar{at}rlbuht.nhs.uk

Abstract

Introduction Endoscopic mucosal resection (EMR) is an invaluable technique, however it is associated with significant risks. In the elderly in particular, the long-term survival benefits of polyp resection with EMR are unknown. The aim of this study was to determine the long-term outcomes in elderly patients who had undergone EMR and to identify any adverse factors.

Method A retrospective observational study on patients of 75 years of age or greater, who underwent EMR of colorectal polyps, in a single tertiary centre, from 2005 to 2014. Demographics of the patients, including Charlson Comorbidity Index (CCI), endoscopic and histological data, were reviewed to identify potential factors predicting outcomes.

Results The patients’ median age was 80 years. In total 239 procedures were performed in 206 unique patients. The complication rate was 1.6%. Mean overall survival was 6.7 years with only one patient dying from metastatic colorectal cancer (0.5%) and 49 dying from non-colorectal cancer conditions (24%). Age more than 79 years and CCI more than 2 were independent predictors of significantly shorter survival (p=<0.01). Gender, size of the removed polyps and total number of polyps were not statistically significantly affecting survival. Patients who had more than two colonoscopies were found to have a survival benefit (p=0.02).

Conclusion EMR of colonic polyps is safe even for elderly patients. However, the decision to proceed to complex endoscopic therapy should be individualised considering the patients’ age and comorbidities. CCI can help to objectively assess the comorbid state of a patient prior to such decisions.

  • endoscopic polypectomy
  • elderly
  • colonic polyps
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Footnotes

  • Contributors All of the authors have made substantial contributions to the conception and design of the study or to the data acquisition and analysis or to the article drafting and they all concur with the submission. TS, AB and SS have written the paper, AG planned the study, AG and LB did the statistical analysis, TS and MJL collected the data, TS submitted the study and SS supervised the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. All the data were collected as part of a registered service evaluation audit with a study period between July 2005 and November 2014. Following statistical analysis and completion of the audit the original spreadsheets have been destroyed as per protocol to maintain confidentiality.

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