Clinical impact and tolerance of unsedated esophagogastroduodenoscopy in patients aged ≥75 years

Purpose: Esophagogastroduodenoscopy (EGD) is widely used in older adults, but concerns persist about tolerance when performed without anesthesia, especially in very old and frail inpatients. We aimed to assess the diagnostic yield, impact on management and tolerance of unsedated EGD in hospitalized patients aged ≥75 years. Methods: We conducted a retrospective single-center study including all inpatients ≥75 years who underwent EGD without general anesthesia or systemic sedation between January 2018 and December 2019. The primary endpoint was a macroscopic lesion consistent with the indication. Secondary endpoints were the contribution of EGD to diagnostic and therapeutic management and endoscopist-rated tolerance (good, intermediate, poor). Results: Two hundred patients were included (mean age 86.8±5.8 years; 53% women; 85% malnourished). A macroscopic lesion consistent with the indication was found in 44% of cases. Overall, EGD was contributory in 83.5% of patients, including 70.5% of those without macroscopic lesions, mainly through treatment changes or additional investigations. Completion rate was 83.5%. Tolerance was rated good in 46.5%, intermediate in 17.5% and poor in 29.5%. In multivariable analysis, lower MMSE score and severe malnutrition remained associated with poor tolerance. Conclusion: In very old inpatients, unsedated EGD remains highly contributory, even when no macroscopic lesion is observed. Simple clinical factors can help anticipate tolerance and support selective, individualized decision-making about EGD in geriatric practice.