EFFICACY AND SAFETY OF ENDOSCOPIC SELF-EXPENDABLE METAL STENTS UTILIZATION IN ELDERLY AND FRAIL PATIENTS
Eliahu Y. Bekhor1,2, Noam Peleg1,2, Tal Livne*1,2, Olga Esepkina1,2, Ory Wiesel3,2
1Rabin Medical Center, Petah Tikva, Central, Israel; 2Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Tel Aviv, Israel; 3The Baruch Padeh Medical Center Poriya, Tiberias, Northern, Israel
Introduction:
In 2000, 600 million persons were over 60 years; it is projected to grow to 2 billion by 2050, estimated 22% of world population. This shift of age toward the elderly pushed us to better understand and personalize our treatment for this unique, rapidly growing, population.
Self-Expendable metal stents (SEMS) for upper gastrointestinal tract obstruction were reported first 30 years ago. Since then SEMS are regarded as an accepted adjunct in the treatment of Upper GIT obstruction, perforation, or leakage, as a definitive treatment, bridge to surgery, or palliation. Currently, there is a deeper understanding of the accumulating impact of comorbidities, Frailty, functional status, and the cognitive state as a predictor of peri-procedural morbidities and mortality rather than chronological age.
We sought to characterize better the efficacy and safety of SEMS in the elderly and frail population in terms of peri-procedural morbidity and mortality and SEMS efficacy.
Methods:
A retrospective data analysis of our prospectively maintained database of patients who underwent endoscopic SEMS between 2018-2021 at our tertiary medical center. Demographics, clinicopathological characteristics, efficacy, and stent-related complications were Compared between elderly patients above the age of 70 years (EG) and a control group (CG) of adult patients. We further stratified the cohort into frail (FG) and non-frail groups (NFG) according to the Memorial Sloan Kettering–Frailty Index (MSK-FI).
Results:
82 patients who underwent endoscopic stent placement in the upper GI tract were identified.36 patients, (ranged 70-94 years) were included in the elderly group and 46 patients (ranged 18-69 years) were included in the CG. No difference was identified in the demographic and clinicopathological characteristics. The indications, SEMS locations, and time from symptoms to stenting were all similar.
There was no statistical significance in the 90-day major morbidity (%, 22 vs 26, p=0.66), mortality (%, 22 vs 20, p=1.00), and length of stay (days, 20 vs 15 p=0.26) between the EG and the CG respectively. SEMS resolved the symptoms for the majority of the patients in the EG and the CG (%, 86 vs 76, p=0.27).
Frail patients were significantly older than non-frail patients (mean age, 75 vs 60 years, P<0.01), besides that, no difference was identified in patients' characteristics. The indications, SEMS locations, and time from symptoms to stenting were all similar. There was no statistical significance in the 90-day major morbidity (%, 24 vs 24, p=1.00), mortality (%, 24 vs 13, p=0.26), and length of stay (days, 24 vs 16 p=0.16) between the FG and the NFG respectively.
Conclusion:
In the era of advanced endoscopic treatments, the utilization of upper GIT SEMS is highly effective both in the elderly and in frail patients with similar risk compared with younger and fitter patients.
Back to 2023 Posters