Safety of esophageal EMR in elderly patients

Background: EMR is commonly used to remove suspicious esophageal lesions among patients with Barrett's esophagus (BE). BE primarily affects older patients. Yet, the safety profile of EMR in elderly patients has not been well-described. Objective: We aimed to study the safety profile of EMR in elderly patients compared with younger patients. Design: Retrospective, observational, descriptive study that used a prospective database. Setting: Tertiary-care referral center. Patients: A total of 136 patients who underwent esophageal EMR for BE. Interventions: EMR with/without ablative therapy. Main Outcome Measurements: The rate of adverse events, including bleeding, stricture formation, and perforation between elderly (aged ≥75 years) and younger (aged<75 years) patients. Results: We identified 136 patients who underwent esophageal EMR who were followed-up in our clinic. Of those, 40% (n = 55) were aged ≥75 years (elderly group) and 60% (n = 81) were aged<75 years (younger group). There was no difference in rate of stricture formation or early or delayed bleeding when we compared elderly patients to younger patients. None of the patients had esophageal perforation. On multivariable logistic regression analysis, controlling for patient sex, EMR technique, and underlying pathology, older age was not associated with increased odds of adverse events (OR 0.88; 95% confidence interval, 0.42-1.9; P = .75). Limitations: Single-center experience. Conclusion: Rates of adverse events from EMR appear to be similar in elderly patients compared with younger patients. Overall, esophageal EMR seems to offer an acceptable safety profile in elderly patients.