Supplementary Material

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Background: Endoscopic submucosal dissection is one of the standard therapies for gastric neoplasms that present with a low probability of lymph node metastasis. However, the validity of the therapy for elderlies has not been fully elucidated. We performed the present retrospective study to clarify the safety and the effectiveness of endoscopic submucosal dissection in elderly patients 80 years of age or older.

Methods: The study subjects included 275 patients (80 years old, n = 54; < 80 years old, n = 221) who underwent endoscopic submucosal dissection for the treatment of gastric tumor between August 1, 2010 and July 31, 2017. From the medical records of the study patients, background factors, lesion factors, and clinical course factors were examined and were compared between patients who were 80 years old or older compared to those who were younger than 80 years old. Additionally, factors related to postoperative bleeding were examined.

Results: Clinical outcomes such as successful resection rate, rate of adverse events, mortality, or days of hospital stay were similar between the two groups. The most common adverse effect in perioperative period was postoperative bleeding, which was significantly related to two factors of whether heparin was used or not and comorbid chronic kidney disease.

Conclusion: The present study indicated that the safety and effectiveness of endoscopic submucosal dissection for elderly patients 80 years old or older is comparable to that for younger patients. Perioperative heparin usage and chronic kidney disease were significant factors related to postoperative bleeding.