Endoscopic Mucosal Resection (Emr) of Colonic Polyps in the Older Patient – is it Safe?

Aims Controversies surround the risk of performing endoscopic mucosal resection (EMR) in patients ≥ 75 years coupled with difficulties encountered with co-morbidities which are often heavily prevalent in this population. We sought to analyse the safety of EMR of large colonic polyps (20mm or greater) in patients ≥ 75 years.

Methods We performed a retrospective analysis of all patients who underwent EMR of polyps ≥ 20mm between 1st January 2019 and 1st January 2020. In our institution, polyps found to be ≥ 20mm at colonoscopy are usually brought back on a different date for a therapeutic procedure. Statistical analyses were performed with GraphPad Prism 6.0 (GraphPad Software, Inc., San Diego, CA). Differences between groups were considered to be significant at a P value of <0.05. Fisher Exact test was used to determine statistical significance.

Results There was no statistically significant difference between patients less than 75 years and those 75 years and above with regard to post EMR admission within 30 days [p = 0.1365 OR: 2.99 (95 % CI: 0.77-11.64)], death within 30 days [p = 0.3091 OR: 6.80 (95 % CI: 0.27-170.0)], perforation [p = 0.5239 OR: 2.26 (95 % CI: 0.14-36.88)] or bleeding [p = 1.00 OR 1.05 (95 % CI: 0.40-2.76)].

Tab. 1 Summary of results

	Age < 75 years	Age 75 years and above
Number of patients	108	47
Admission within 30 days/Death within 30 days	4/0	5/1
Perforation	1 – required right hemicolectomy	1 – micro-perforation
Bleeding (including delayed)	15 (3)	7 (2)

Conclusions Our analysis shows that EMR in patients ≥ 75 years appears to be safe. However, given that this is a retrospective analysis there are confounding factors such as pre-selected patients for therapeutic intervention. Further large-scale prospective research is required to determine outcomes such as cancer prevention benefit as well as cost effectiveness. The use of life expectancy scores may play a role in deciding which patients should have surveillance +/- therapeutic intervention in the future.

Citation: Garvey T, Hadjinicolaou A, Frank M et al. eP1 ENDOSCOPIC MUCOSAL RESECTION (EMR) OF COLONIC POLYPS IN THE OLDER PATIENT – IS IT SAFE? Endoscopy 2021; 53: S97.

Publikationsverlauf

Artikel online veröffentlicht:
19. März 2021