Short‐ and Long‐Term Outcomes of Endoscopic Submucosal Dissection for Gastric Lesions in Elderly Patients Aged 80 Years or Older: Focus on Non‐Procedure‐Related Adverse Events

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ABSTRACT Objectives With an aging society, the proportion of elderly patients undergoing gastric endoscopic submucosal dissection (ESD) is increasing. Although procedure‐related adverse events (AEs) are comparable between the elderly and non‐elderly patients, data on non‐procedure‐related AEs remain limited. This study aimed to evaluate the short‐ and long‐term outcomes of gastric ESD in elderly patients, focusing on risk factors for non‐procedure‐related AEs. Methods We retrospectively analyzed 941 patients who underwent gastric ESD at two institutions between 2011 and 2024. Patients were stratified into elderly (≥80 years) and non‐elderly (<80 years) groups, and short‐ and long‐term outcomes were compared. Procedure‐related AEs included delayed bleeding, perforation, and stricture, whereas non‐procedure‐related AEs included pneumonia and other systemic complications. Results Procedure‐related AE rates were similar between the groups (8.9% vs. 7.1%, p = 0.322), whereas the overall (13.8% vs. 8.3%, p = 0.010) and non‐procedure‐related AE rates (5.8% vs. 1.4%, p < 0.001) were significantly higher in elderly patients. Univariate analysis showed that Eastern Cooperative Oncology Group performance status (PS) ≥ 2 and Charlson Comorbidity Index (CCI) ≥ 2 were significant risk factors for non‐procedure‐related AEs among elderly patients. Non‐procedure‐related AEs were significantly associated with poorer overall survival (OS) ( p = 0.013). Multivariate analysis identified systemic factors, including age, albumin level, CCI, and PS, as independent prognostic factors for OS in elderly patients. Conclusions Assessment of systemic health status, particularly using PS and CCI, is essential for predicting non‐procedure‐related AEs, and they are useful indices for determining treatment indications in elderly patients undergoing gastric ESD. Trial Registration : Not applicable.

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