Impact of Age and Comorbidities on Colorectal Endoscopic Submucosal Dissection Outcomes: a large multicenter study in a Western cohort.

Background: Endoscopic submucosal dissection (ESD) has emerged as the standard treatment for colorectal lesions. Considering the global population ageing, we aimed to assess the effectiveness and safety of colorectal ESD in patients aged ≥ 80 compared to 65-79 on a large Western cohort. Methods: We retrospectively enrolled patients aged >64 years undergoing colorectal ESD, classifying them into Very Elderly Group (VE-Group, age>80 yo) and Elderly group (E-Group, 65-79 yo). Procedure outcomes and safety were compared between VE-Group and E-Group and between patients with comorbidities and healthy (1-CM-Group and H-Group). Results: A total of 980 patients were included [269 (27,5%) in VE-Group and 711 (72,5%) in E-Group]. En-bloc, R0, and oncological curative resection rates did not differ, as well as intra and post-procedural adverse events (AEs). Delirium occurrence was registered in VE-group [6 (2.2%) in VE-Group vs 1 (0.1%) in E-Group; P=0.001; OR=16.2(95%CI:1.9-135.2)]. 1-CM-Group showed a higher rate of intraprocedural bleeding (P=0.001), delayed perforation (P=0.03) fever onset (P<0.001) and systemic infections (P=0.02) compared to the H-Group. Having one or more comorbidities was associated with increased overall AEs [P<0.001; OR:2.3(95%CI:1.5-3.6)]. Conclusion: Colorectal ESD is a feasible procedure for old patients. Physicians should consider delirium a possible AE in patients over 80. These findings, which bridge the gap between Asian and Western clinical data, underscore the importance of tailored pre- and post-procedural assessments in a global clinical context.