Short-Term Safety of Gastric Endoscopic Submucosal Dissection in Patients Aged 80 Years or Older Under a Standardized Inpatient Post-Procedural Surveillance Pathway: Data from a 13-Year Real-World Cohort Study

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Background/Objectives: Gastric endoscopic submucosal dissection (ESD) is an established organ-preserving treatment for gastric neoplasia, but the short-term safety of ESD in patients aged 80 years or older remains clinically important. We evaluated the efficacy and short-term safety of gastric ESD in patients aged ≥80 years treated under a standardized inpatient post-procedural surveillance pathway. Methods: This retrospective cohort study included 2021 consecutive unique patients who underwent gastric ESD for gastric adenoma or gastric cancer at a single institution between April 2013 and March 2026. Patients were classified as <80 years or ≥80 years. Standard hospitalization was 3 nights/4 days for patients not receiving antithrombotic agents and 5 nights/6 days for those receiving antithrombotic agents. The primary safety outcomes were post-ESD bleeding, perforation, pneumonia, and delirium. Absolute risk differences with 95% confidence intervals (CIs) were calculated, and multivariable logistic regression was performed to evaluate the association between age ≥ 80 years and selected efficacy and safety outcomes. Results: Among the 2021 patients, 285 were aged ≥80 years and 1736 were aged <80 years. Non-curative resection was more frequent in patients aged ≥80 years (7.7% vs. 4.6%; p = 0.026), but this difference was not significant after lesion-adjusted analysis. Post-ESD bleeding (2.5% vs. 2.4%), perforation (0.4% vs. 0.7%), and pneumonia (0% vs. 0.1%) were comparable between groups, while delirium occurred in one patient aged ≥80 years. No 30-day mortality occurred in either group. In multivariable analysis, age ≥ 80 years was not independently associated with post-ESD bleeding or perforation, and the primary safety findings were similar after propensity-score matching. Conclusions: In this single-center cohort, gastric ESD in selected patients aged ≥80 years was not independently associated with non-curative resection or increased short-term adverse outcomes. Chronological age alone should not preclude gastric ESD when standardized monitoring and individualized risk assessment are applied.