Safety of endoscopic mucosal resection of large colonic polyps in elderly patients: a systematic review and meta-analysis

BACKGROUND: Endoscopic mucosal resection (EMR) is a procedure commonly used for large sessile and flat polyps. However, it may cause bleeding, perforation, and complications related to anesthesia. There are limited data on the safety and efficacy of EMR in the elderly. Therefore, we conducted a comprehensive review and meta-analysis to assess EMR safety in elderly patients. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection for studies evaluating EMR for large colorectal lesions (>20 mm) in older patients (75+ years). Our primary result was post-polypectomy bleeding and perforation, while our secondary outcome was recurrence or residual polyp. RESULTS: The meta-analysis included 6 studies with 2903 patients. The rate of post-polypectomy bleeding was 5.3% (95% confidence interval [CI] 2.3-11.7%), I(2)=73.7%; and perforation was 1.9% (95%CI 0.9-3.8%), I(2)=0%, in patients over 75 years old. The pooled risk of post-polypectomy bleeding was 2.4%, 95%CI 1.2-4.8%, I(2)=0%; and perforation was 2.1%, 95%CI 0.7-5.8%, I(2)=8.6%, in patients over 80 years old. The risk of post-polypectomy bleeding (odds ratio [OR] 0.922, 95%CI 0.359-2.367, I(2)=0%); and perforation (OR 1.066, 95%CI 0.188-6.031, I(2)=0%) did not differ significantly between patients aged over 80 and younger patients. The pooled rate of residual or recurrence of polyps in patients aged over 80 was significantly higher (25%, 95%CI 17-35.3%, I(2)=59.5%) vs. younger patients (OR 2.234, 95%CI 1.549-3.223, I(2)=0%). CONCLUSION: EMR is as safe for the elderly as it is for younger patients, and is not associated with a greater risk of bleeding or perforation.