S3164 Safety and Efficacy of Endoscopic Submucosal Dissection for Early Gastric Cancer Among Elderly Population: A Systematic Review and Meta-Analysis

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 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% confidence interval [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. 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). Conclusion: This comprehensive study demonstrated that ESD is not only a safe but also an effective procedure for treating 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.