Aging Clinical and Experimental Research

, Volume 29, Supplement 1, pp 109–113 | Cite as

Endoscopic mucosal resection in elderly patients

  • Stefano Pontone
  • Rossella Palma
  • Cristina Panetta
  • Daniele Pironi
  • Chiara Eberspacher
  • Rita Angelini
  • Paolo Pontone
  • Antonio Catania
  • Angelo Filippini
  • Salvatore Sorrenti
Original Article



Endoscopic mucosal resection (EMR) of early superficial colorectal carcinomas is nowadays accepted as the gold standard treatment for this type of neoplasia.


This study aims to evaluate the efficacy and safety of mucosectomy in elderly patients considering the predictive value of submucosal infiltration.


A retrospective study of all patients referred for EMR of sessile colorectal polyps classified IIa by the Paris classification between April 2013 and April 2015. A total of 50 patients (30 males (60 %); age range = 44–86; mean age = 67.7) were enrolled. Patients were divided in two groups considering 65 years as cutoff to individuate the elderly patients.


EMR was performed in 53 lesions: 39 were performed en bloc and 14 by piecemeal technique. 30 % of lesions were in the rectum; 11 % in the sigmoid colon; 15 % in the descending colon; 6 % in the transverse colon; 24 % in the ascendant colon; and 14 % in the cecum. The mean size of the resected specimens was 20 mm (range 8–80 mm). The rate of complete resection was 79.2 %, incomplete 13.2 %, not estimable 7 %. Ten patients underwent surgery because of an incomplete resection and/or histological evaluation.


Colon EMR is safe and effective in elderly patients. Endoscopy is still helped in the correct indication for surgery in high-risk surgical patients.


Elderly patients Lifting sign Endoscopic resection Submucosal invasion Polyp Colonoscopy Colorectal cancer 



Endoscopic submucosal resection


Lymph node




Non-lifting sign


Argon plasma coagulator


Compliance with ethical standards

Conflict of interest

All authors listed have contributed sufficiently to the project to be included as authors, and to the best of our knowledge, no conflict of interest, financial or other exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.


The authors declare that they have received no funding for the study.

Informed consent

Informed consent to the endoscopic procedure and to the processing of own personal data was obtained from each individual study participant. In accordance with Italian Drug Agency (AIFA) guidelines, observational studies using retrospective data or materials do not require formal approval by the local ethics committee. Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Othman MO, Wallace MB (2011) Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in 2011, a Western perspective. Clin Res Hepatol Gastroenterol 35:288–294CrossRefPubMedGoogle Scholar
  2. 2.
    Repici A, Pellicano R, Strangio G et al (2009) Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes. Dis Colon Rectum 52:1502–1515CrossRefPubMedGoogle Scholar
  3. 3.
    Hurlstone DP, Cross SS, Adam I et al (2004) Endoscopic morphological anticipation of submucosal invasion in flat and depressed colorectal lesions: clinical implications and subtype analysis of the kudo type V pit pattern using high-magnification-chromoscopic colonoscopy. Colorectal Dis 6:369–375CrossRefPubMedGoogle Scholar
  4. 4.
    Moss A, Bourke MJ, Williams SJ et al (2011) Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosalneoplasia. Gastroenterology 140:1909–1918CrossRefPubMedGoogle Scholar
  5. 5.
    Abdelmessih R, Packey CD, Lawlor G (2016) Endoscopy in the elderly: a cautionary approach, when to stop. Curr Treat Options Gastroenterol 14:305–314CrossRefPubMedGoogle Scholar
  6. 6.
    Uno Y, Munakata A (1994) The non-lifting sign of invasive colon cancer. Gastrointest Endosc 40:485–489CrossRefPubMedGoogle Scholar
  7. 7.
    Faiz O, Haji A, Bottle A et al (2011) Elective colonic surgery for cancer in the elderly: an investigation into postoperative mortality in English NHS hospitals between 1996 and 2007. Colorectal Dis 13:779–785. doi: 10.1111/j.1463-1318.2010.02290.x CrossRefPubMedGoogle Scholar
  8. 8.
    Pommergaard HC, Burcharth J, Rosenberg J et al (2016) Advanced age is a risk factor for proximal adenoma recurrence following colonoscopy and polypectomy. Br J Surg 103:e100–e105. doi: 10.1002/bjs.10069 CrossRefPubMedGoogle Scholar
  9. 9.
    The Paris endoscopic classification of superficial neoplastic lesions (2003) esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 58(6 Suppl):S3–S43Google Scholar
  10. 10.
    Adolph RJ (1990) The elderly, the very elderly and traditional practice patterns. J Am Coll Cardiol 16:793CrossRefPubMedGoogle Scholar
  11. 11.
    Watanabe T, Itabashi M, Shimada Y et al (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17:1–29. doi: 10.1007/s10147-011-0315-2 CrossRefPubMedGoogle Scholar
  12. 12.
    Xie HQ, Zhong WZ (2016) Outcomes of colonic endoscopic mucosal resection for large polyps in elderly patients. J Laparoendosc Adv Surg Tech A 26:707–709CrossRefPubMedGoogle Scholar
  13. 13.
    Se Kudo, Lambert R, Allen JI et al (2008) Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 68(4 Suppl):S3–S47. doi: 10.1016/j.gie.2008.07.052 Google Scholar
  14. 14.
    Cipolletta L, Rotondano G, Bianco MA et al (2014) Endoscopic resection for superficial colorectal neoplasia in Italy: a prospective multicentre study. Italian Colorectal Endoscopic Resection (ICER) Study Group. Dig Liver Dis 46:146–151. doi: 10.1016/j.dld.2013.09.019 CrossRefPubMedGoogle Scholar
  15. 15.
    Perrotta S, Quarto G, Desiato V et al (2013) TEM in the treatment of recurrent rectal cancer in elderly. BMC Surg 13(Suppl. 2):S56. doi: 10.1186/1471-2482-13-S2-S56 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Quarto G, Sivero L, Benassai G et al (2014) TEM in the treatment of recurrent rectal cancer in elderly. Ann Ital Chir 85:101–104PubMedGoogle Scholar
  17. 17.
    Compagna R, Serra R, Sivero L et al (2015) Tailored treatment of intestinal angiodysplasia in elderly. Open Med. doi: 10.1515/med-2015-009 Google Scholar
  18. 18.
    Quarto G, Sivero L, Benassai G et al (2013) Early rectal cancer: local excision by Trans-anal Endoscopic Microsurgery (T.E.M.). Ann Ital Chir 84:437–439PubMedGoogle Scholar
  19. 19.
    Luglio G, Sivero L, Tarquini R et al (2013) Functional results after TME for rectal cancer: J-pouch versus coloplasty. A single institution prospective study. Chirurgia (Turin) 26:283–286Google Scholar
  20. 20.
    Giglio MC, Persico M, Quarto G et al (2013) Intersphinteric resection for rectal cancer: role in fecal continence and quality of life. Ann Ital Chir 84:287–290PubMedGoogle Scholar
  21. 21.
    Luglio G, Tarquini R, Sivero L et al (2013) Risultati funzionali e oncologici dopo escissione locale transanale per cancro del retto. Uno studio prospettico. Chirurgia 26:337–340Google Scholar
  22. 22.
    Gentile M, de Rosa M, Cestaro G et al (2014) Internal Delorme vs. STARR procedure for correction of obstructed defecation from rectocele and rectal intussusception. Ann Ital Chir 85:177–183PubMedGoogle Scholar
  23. 23.
    Cardin F, Andreotti A, Zorzi M et al (2012) Usefulness of a fast track list for anxious patients in a upper GI endoscopy. BMC Surg 12(Suppl 1):S11. doi: 10.1186/1471-2482-12-S1-S11 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Sivero L, Galloro G, Formisano C et al (2013) Morphological and molecular features of apoptosis and its role in colorectal cancer prevention. Chirurgia (Turin) 26:269–273Google Scholar
  25. 25.
    Amato B, Donisi M, Rispoli C et al (2013) Enhanced recovery after surgery (ERAS) program in the elderly: is it feasible? Chirurgia (Turin) 26:307–330Google Scholar
  26. 26.
    Ishiguro A, Uno Y, Ishiguro Y et al (1999) Correlation of lifting versus non-liftingand microscopic depth of invasion in early colorectal cancer. Gastrointest Endosc 50:329–333CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Stefano Pontone
    • 1
  • Rossella Palma
    • 1
  • Cristina Panetta
    • 1
  • Daniele Pironi
    • 1
  • Chiara Eberspacher
    • 1
  • Rita Angelini
    • 1
  • Paolo Pontone
    • 1
  • Antonio Catania
    • 1
  • Angelo Filippini
    • 1
  • Salvatore Sorrenti
    • 1
  1. 1.Department of Surgical Sciences“Sapienza” University of RomeRomeItaly

Personalised recommendations