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BMC Gastroenterology
Published in: BMC Gastroenterology 1/2020

Open Access 01-12-2020 | Pneumonia | Research article

Association between Charlson comorbidity index and complications of endoscopic resection of gastric neoplasms in elderly patients

Authors: Sunmin Kim, Dong Hyun Kim, Seon-Young Park, Chang Hwan Park, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew

Published in: BMC Gastroenterology | Issue 1/2020

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Abstract

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.
Literature
1.
Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006;64(6):877–83.PubMedCrossRef
2.
Takeuchi Y, Uedo N, Iishi H, Yamamoto S, Yamamoto S, Yamada T, Higashino K, Ishihara R, Tatsuta M, Ishiguro S. Endoscopic submucosal dissection with insulated-tip knife for large mucosal early gastric cancer: a feasibility study (with videos). Gastrointest Endosc. 2007;66(1):186–93.PubMedCrossRef
3.
Oda I, Gotoda T, Hamanaka H, Eguchi T, Saito Y, Matsuda T, Bhandari P, Emura F, Saito D, Ono H. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc. 2005;17(1):54–8.CrossRef
4.
Tokioka S, Umegaki E, Murano M, Takeuchi N, Takeuchi T, Kawakami K, Yoda Y, Kojima Y, Higuchi K. Utility and problems of endoscopic submucosal dissection for early gastric cancer in elderly patients. J Gastroenterol Hepatol. 2012;27(Suppl 3):63–9.PubMedCrossRef
5.
Kakushima N, Fujishiro M, Kodashima S, Muraki Y, Tateishi A, Yahagi N, Omata M. Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population. J Gastroenterol Hepatol. 2007;22(3):311–4.PubMedCrossRef
6.
Hirasaki S, Tanimizu M, Nasu J, Shinji T, Koide N. Treatment of elderly patients with early gastric cancer by endoscopic submucosal dissection using an insulated-tip diathermic knife. Intern Med. 2005;44(10):1033–8.PubMedCrossRef
7.
Isomoto H, Ohnita K, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Akiyama M, Ozawa E, Nakao K, Kohno S, et al. Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol. 2010;22(3):311–7.PubMedCrossRef
8.
Zhang Y, Huang L, Li L, Ji F. Endoscopic submucosal dissection for early gastric neoplasms in elderly patients. J Laparoendosc Adv Surg Tech A. 2014;24(6):391–8.PubMedCrossRef
9.
From the Centers for Disease Control and Prevention. Public health and aging: trends in aging--United States and worldwide. JAMA. 2003;289(11):1371–3.
10.
Fried L, Barron J. In: Handbook of Urban Health: Chapter 9. Older Adults; 2005. p. 177–99.
11.
Quine MA, Bell GD, McCloy RF, Charlton JE, Devlin HB, Hopkins A. Prospective audit of upper gastrointestinal endoscopy in two regions of England: safety, staffing, and sedation methods. Gut. 1995;36(3):462–7.PubMedPubMedCentralCrossRef
12.
McLernon DJ, Donnan PT, Crozier A, Dillon J, Mowat C. A study of the safety of current gastrointestinal endoscopy (EGD). Endoscopy. 2007;39(8):692–700.PubMedCrossRef
13.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRef
14.
Goldstein LB, Samsa GP, Matchar DB, Horner RD. Charlson index comorbidity adjustment for ischemic stroke outcome studies. Stroke. 2004;35(8):1941–5.PubMedCrossRef
15.
Hemmelgarn BR, Manns BJ, Quan H, Ghali WA. Adapting the Charlson comorbidity index for use in patients with ESRD. Am J Kidney Dis. 2003;42(1):125–32.PubMedCrossRef
16.
Lee DS, Donovan L, Austin PC, Gong Y, Liu PP, Rouleau JL, Tu JV. Comparison of coding of heart failure and comorbidities in administrative and clinical data for use in outcomes research. Med Care. 2005;43(2):182–8.PubMedCrossRef
17.
Myers RP, Quan H, Hubbard JN, Shaheen AA, Kaplan GG. Predicting in-hospital mortality in patients with cirrhosis: results differ across risk adjustment methods. Hepatology. 2009;49(2):568–77.PubMedCrossRef
18.
Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, Mallery JS, Raddawi HM, Vargo JJ 2nd, Waring JP, et al. Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures. Gastrointest Endosc. 2002;55(7):775–9.PubMedCrossRef
19.
Early DS, Lightdale JR, Vargo JJ 2nd, Acosta RD, Chandrasekhara V, Chathadi KV, Evans JA, Fisher DA, Fonkalsrud L, Hwang JH, et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018;87(2):327–37.PubMedCrossRef
20.
Yang TC, Hou MC, Chen PH, Hsin IF, Chen LK, Tsou MY, Lin HC, Lee FY. Clinical outcomes and complications of endoscopic submucosal dissection for superficial gastric neoplasms in the elderly. Medicine (Baltimore). 2015;94(44):e1964.CrossRef
21.
Kim SY, Sung JK, Moon HS, Kim KS, Jung IS, Yoon BY, Kim BH, Ko KH, Jeong HY. Is endoscopic mucosal resection a sufficient treatment for low-grade gastric epithelial dysplasia? Gut Liver. 6(4):446–51.
22.
Chinda D, Sasaki Y, Tatsuta T, Tsushima K, Wada T, Shimoyama T, Fukuda S. Perioperative complications of endoscopic submucosal dissection for early gastric cancer in elderly Japanese patients 75 years of age or older. Intern Med. 2015;54(3):267–72.PubMedCrossRef
23.
Duggan M, Kavanagh BP. Atelectasis in the perioperative patient. Curr Opin Anaesthesiol. 2007;20(1):37–42.PubMedCrossRef
24.
Ray K, Bodenham A, Paramasivam E. Pulmonary atelectasis in anaesthesia and critical care. Cont Educ Anaesth Crit Care Pain. 2013;14(5):236–45.CrossRef
25.
Restrepo RD, Braverman J. Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis. Expert Rev Respir Med. 2015;9(1):97–107.PubMedCrossRef
26.
Tusman G, Böhm SH, Warner DO, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Curr Opin Anaesthesiol. 2012;25(1):1–10.PubMedCrossRef
27.
Choe JW, Jung SW, Song JK, Shim E, Choo JY, Kim SY, Hyun JJ, Koo JS, Yim HJ, Lee SW. Predictive factors of atelectasis following endoscopic resection. Dig Dis Sci. 2016;61(1):181–8.PubMedCrossRef
28.
Park CH, Kim H, Kang YA, Cho IR, Kim B, Heo SJ, Shin S, Lee H, Park JC, Shin SK, et al. Risk factors and prognosis of pulmonary complications after endoscopic submucosal dissection for gastric neoplasia. Dig Dis Sci. 2013;58(2):540–6.PubMedCrossRef
29.
Yang CC, Fong Y, Lin LC, Que J, Ting WC, Chang CL, Wu HM, Ho CH, Wang JJ, Huang CI. The age-adjusted Charlson comorbidity index is a better predictor of survival in operated lung cancer patients than the Charlson and Elixhauser comorbidity indices. Eur J Cardio Thor Surg. 2018;53(1):235–40.CrossRef
30.
Bannay A, Chaignot C, Blotiere PO, Basson M, Weill A, Ricordeau P, Alla F. The best use of the Charlson comorbidity index with electronic health care database to predict mortality. Med Care. 2016;54(2):188–94.PubMedCrossRef
31.
Bonaventura A, Leale I, Carbone F, Liberale L, Dallegri F, Montecucco F, Borgonovo G. Pre-surgery age-adjusted Charlson comorbidity index is associated with worse outcomes in acute cholecystitis. Digest Liver Dis. 2019;51(6):858–63.CrossRef
Metadata
Title
Association between Charlson comorbidity index and complications of endoscopic resection of gastric neoplasms in elderly patients
Authors
Sunmin Kim
Dong Hyun Kim
Seon-Young Park
Chang Hwan Park
Hyun Soo Kim
Sung Kyu Choi
Jong Sun Rew
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2020
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-020-01360-6

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