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Association Between Charlson Comorbidity Index and Complications of Endoscopic Resection of Gastric Neoplasms in Elderly Patients
Seon-Young Park
Chonnam National University Hospital
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Gastroenterology.
Background: Although endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities. Further, the relationship between comorbidities and complications of endoscopic resection is not well established. Therefore, we aimed to evaluate the efficacy and safety of endoscopic resection of gastric epithelial neoplasms in extremely elderly patients.
Methods: From October 2008 to December 2017, 4475 consecutive patients underwent endoscopic resection of gastric epithelial neoplasms. Among them, 242 were 75 years or older. We assessed Charlson comorbidity index (CCI) scores, procedural outcomes, and procedure- and sedation-related complications related to endoscopic resection.
Results: Mean patient age was 78.7 ± 3.2 years. Of the 242 patients, 124 (51.2%) had low-grade dysplasia and 112 (46.3%) had adenocarcinoma. The most common comorbidity was hypertension (55.4%), followed by diabetes (23.1%). The mean CCI score was 1.67 ± 1.43. Sixty patients (24.8%) had a CCI score ≥ 3. During the procedure, 10 (4.1%) patients had desaturation that recovered by flumazenil use with mask (n=2) or Ambu bag (n=3) ventilation. During subsequent admission, atelectasis or pneumonia occurred in 45 (18.6%) patients, post-procedural bleeding in 12 (5.0%), and perforation in 3 (1.2%). Respiratory complications were more common in patients with a CCI score ≥ 3 (20/60, 33.3%) than in those with a CCI score < 3 (25/182, 13.7%, P=0.002).
Conclusions: CCI score is related to respiratory complications of endoscopic resection in extremely elderly patients. Endoscopic resection must be performed cautiously, particularly in elderly patients with a high CCI score, to prevent respiratory complications.
Keywords
Endoscopic mucosal resection, Aged, Comorbidity, Stomach neoplasms
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CURRENT STATUS: Published
Version 2
Posted 28 May, 2020
Published
On 09 Jul, 2020
No community comments so far
Editorial decision: Minor revision
On 23 Jun, 2020
Review #1 received
Received 17 Jun, 2020
Reviewer #2 agreed
On 29 May, 2020
Review #2 received
Received 29 May, 2020
Reviewers invited
Invitations sent on 28 May, 2020
Reviewer #1 agreed
On 28 May, 2020
Editor assigned
On 19 May, 2020
Submission checks complete
On 18 May, 2020
Editor invited
On 18 May, 2020
No comments provided
Editorial decision: Major revision
On 30 Apr, 2020
Review #2 received
Received 27 Apr, 2020
Reviewer #2 agreed
On 26 Apr, 2020
Review #1 received
Received 03 Jan, 2020
Reviewer #1 agreed
On 20 Dec, 2019
Reviewers invited
Invitations sent on 05 Dec, 2019
Submission checks complete
On 29 Oct, 2019
Editor assigned
On 25 Oct, 2019
First submitted
On 24 Oct, 2019
Editor invited
On 24 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastroenterology & Hepatology
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This preprint is under consideration at BMC Gastroenterology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Association Between Charlson Comorbidity Index and Complications of Endoscopic Resection of Gastric Neoplasms in Elderly Patients
Seon-Young Park
Chonnam National University Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 28 May, 2020
Published
On 09 Jul, 2020
No community comments so far
Editorial decision: Minor revision
On 23 Jun, 2020
Review #1 received
Received 17 Jun, 2020
Reviewer #2 agreed
On 29 May, 2020
Review #2 received
Received 29 May, 2020
Reviewers invited
Invitations sent on 28 May, 2020
Reviewer #1 agreed
On 28 May, 2020
Editor assigned
On 19 May, 2020
Submission checks complete
On 18 May, 2020
Editor invited
On 18 May, 2020
No comments provided
Editorial decision: Major revision
On 30 Apr, 2020
Review #2 received
Received 27 Apr, 2020
Reviewer #2 agreed
On 26 Apr, 2020
Review #1 received
Received 03 Jan, 2020
Reviewer #1 agreed
On 20 Dec, 2019
Reviewers invited
Invitations sent on 05 Dec, 2019
Submission checks complete
On 29 Oct, 2019
Editor assigned
On 25 Oct, 2019
First submitted
On 24 Oct, 2019
Editor invited
On 24 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastroenterology & Hepatology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Gastroenterology.
Background: Although endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities. Further, the relationship between comorbidities and complications of endoscopic resection is not well established. Therefore, we aimed to evaluate the efficacy and safety of endoscopic resection of gastric epithelial neoplasms in extremely elderly patients.
Methods: From October 2008 to December 2017, 4475 consecutive patients underwent endoscopic resection of gastric epithelial neoplasms. Among them, 242 were 75 years or older. We assessed Charlson comorbidity index (CCI) scores, procedural outcomes, and procedure- and sedation-related complications related to endoscopic resection.
Results: Mean patient age was 78.7 ± 3.2 years. Of the 242 patients, 124 (51.2%) had low-grade dysplasia and 112 (46.3%) had adenocarcinoma. The most common comorbidity was hypertension (55.4%), followed by diabetes (23.1%). The mean CCI score was 1.67 ± 1.43. Sixty patients (24.8%) had a CCI score ≥ 3. During the procedure, 10 (4.1%) patients had desaturation that recovered by flumazenil use with mask (n=2) or Ambu bag (n=3) ventilation. During subsequent admission, atelectasis or pneumonia occurred in 45 (18.6%) patients, post-procedural bleeding in 12 (5.0%), and perforation in 3 (1.2%). Respiratory complications were more common in patients with a CCI score ≥ 3 (20/60, 33.3%) than in those with a CCI score < 3 (25/182, 13.7%, P=0.002).
Conclusions: CCI score is related to respiratory complications of endoscopic resection in extremely elderly patients. Endoscopic resection must be performed cautiously, particularly in elderly patients with a high CCI score, to prevent respiratory complications.
Figure 1
Figure 2
Figure 3