Characteristics and outcomes of colorectal EMR in elderly and very elderly patients versus younger patients in the cradle of the Mediterranean diet

Aims The evidence guiding the use of Endoscopic mucosal resection (EMR) in elderly and very elderly patients remains limited. It’s known that the Mediterranean diet (MD) has healthy properties, and Cilento is an area in southern Italy, considered the cradle of the MD, with a high number of long-living individuals [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ] [ 9 ] [ 10 ] [ 11 ] [ 12 ] [ 13 ] [ 14 ] [ 15 ] [ 16 ] [ 17 ] [ 18 ] [ 19 ] [ 20 ] [ 21 ] [ 22 ] [ 23 ]. The primary outcome was to evaluate the safety and efficacy of EMR in these patients. Furthermore, we aimed to identify specific variables correlated with age to contribute to a more tailored approach in this growing patient group, particularly in our geographic area ([ Table 1 ]). Table 1 Age<65 y (n=145) Age≥65 y (n=257) P value Age<80 y (n=344) Age≥80 y (n=58) P value Women 59 (40,7%) 85 (33,1%) 0.115 125 (36,3%) 18 (31,0%) 0.527 Mean age, y (Standard deviation) 55,7 (7,3) 74,2 (6,4) <0.001* 64,9 (9,7) 83,3 (3) <0.001* Number of polyps 167 305 402 70 Location of polyps 0.983 0.958 Rectus 16 (9,6%) 28 (9,2%) 1.000 36 (9%) 8 (11,4%) 0.601 Sigma 62 (37,1%) 112 (36,8%) 0.956 146 (36,3%) 28 (40%) 0.493 Descending 18 (10,8%) 32 (10,5%) 1.000 43 (10,7%) 7 (10%) 1.000 Transverse 19 (11,4%) 34 (11,2%) 1.000 46 (11,4%) 7 (10%) 0.951 Ascending 35 (21%) 72 (23,7%) 0.467 93 (23,13%) 14 (20%) 0.763 Cecum 17 (10,2%) 26 (8,6%) 0.739 38 (9,5%) 6 (8,6%) 1.000 Pathology of polyps 0.195 0.076 Hyperplastic 27 (17,9%) 31 (11,5%) 0.077 20 (6,1%) 7 (11,7%) 0.160 Serrated 4 (2,6%) 11 (4,1%) 0.588 14 (4,0%) 1 (1,6%) 0.484 Adenomatous 115 (76,16%) 215 (79,6%) 0.459 284 (86,1%) 46 (76,7%) 0.079 Adenocarcinoma 5 (3,3%) 13 (4,8%) 0.617 12 (3,6%) 6 (10%) 0.043* Patients with follow-up examination 11 (7,6%) 23 (8,9%) 0.763 24 (7,1%) 3 (5,2%) 0.794 Methods We conducted a multicenter retrospective study analyzing 402 patients undergoing EMR for colorectal lesions≥10 mm between January 2020 and April 2025. Patients were stratified into age groups:<65 vs≥65 years, and<80 vs≥80 years. Demographics, polyp characteristics, technical outcomes, histology, and adverse events were compared between groups. A subanalysis was performed to evaluate the outcomes for lesions≥20 mm. Correlation analyses explored the associations between clinical, procedural, and histological variables. Results EMR achieved high technical success across all age groups, with complication rates of 2.4% in patients<65 years and 4.8% in those≥65 years, and no perforations in any group. In patients aged 80 years or older, the prevalence of adenocarcinoma was significantly higher (10% vs. 3.6%, p=0.043), and a moderate correlation was observed between lesion size and high-grade dysplasia/adenocarcinoma (r=0.64). Younger patients more frequently underwent en bloc resection, while elderly patients presented with more complex lesions. Follow-up rates remained low across groups. Conclusions EMR is a safe and effective technique for removing colorectal polyps in elderly and very elderly patients, with complication rates and efficacy comparable to those in younger cohorts. Age alone should not preclude EMR. A comprehensive patient-centred assessment, including lesion characteristics, comorbidities, and life expectancy, optimises outcomes. Vigilant surveillance is recommended for elderly and very elderly patients, particularly for large lesions due to their higher malignant potential. Publication History Article published online: 05 June 2026 © 2026. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany