목적: 위 종양이 있는 고령 환자들은 동반된 질환에 의한 수술의 위험성이 증가하므로, 치료 방법의 선택이 중요하다. 내시경 점막하 박리술은 수술 후 동반될 수 있는 합병증 및 사망률이 낮고, 일괄절제 및 완전절제의 장점이 있다. 저자들은 선종 및 조기 위암을 가진 고령의 환자에서 내시경 점막하 박리술의 유용성 및 안정성에 대해 알아보고자 하였다. 대상 및 방법: 조사기간 본원에서 점막하 박리술(전기절개도를 이용한 내시경 점막하 박리법 및 전기절개도를 이용한 점막 절개 및 점막하 박리 후 올가미 절제법)을 시행 받은 268명을 대상으로 하였으며, 65세 이상의 고령군은 123명이었다. 내시경 점막하 박리술의 절대적 적응증은 1) 종양의 크기와 모양에 관계없이 이전 조직 검사에서 선종으로 진단된 경우, 2) 이전 내시경 검사에서 궤양을 동반하지 않는 분화된 점막 병변으로 하였다. 고령군과 비고령군에서 일괄절제율, 완전절제율 및 합병증 발생률을 후향적으로 비교하였다. 결과: 고령군의 평균 나이는 71.1 (65∼87)세였으며, 53.7% (66/123)에서 한 가지 이상의 동반된 질환을 가지고 있었다. 조직검사 상 51.2% (63/123)에서 선암으로 최종 진단되었다. 일괄절제율은 98.4% (121/123), 완전절제율은 86.2% (106/123)로 일괄, 완전절제가 동시에 이루어진 경우는 85.4% (105/123)에서 이루어졌다. 천공 및 출혈의 합병증은 22.0% (27/123)에서 발생했다. 천공은 4.1% (5/123)에서 발생했으나 내시경 치료 및 보존 치료로 회복되었다. 출혈은 17.1% (21/123)에서 발생했으며, 수혈이 필요할 정도의 대량 출혈은 한 건도 발생하지 않았다. 내시경 점막하 박리술을 시행 받은 고령 환자에서 일괄절제 및 완전절제율과 천공 및 출혈의 합병증 발생률은 비고령군과 비교 시 유의한 차이가 없었다. 결론: 고령 환자의 위종양 치료에 있어 내시경 점막하 박리술은 안전하고 유용한 치료법이다.

Background/Aims: Elderly patients often have high operative risk due to their comorbid diseases, and the feasibility of performing endoscopic submucosal dissection (ESD) for such patients should be investigated. The aim of this study is to evaluate the efficacy and safety of performing ESD in elderly patients. Methods: From 2005 to 2007, 269 patients with gastric neoplasm were treated by ESD in our hospital. These patients were divided into the elderly patients who were 65 years of age or older and the younger patients. The number of enrolled elderly patients was 123. The en bloc complete resection rate and the complications were assessed and compared with those of the younger patients. Results: The average age of the old age group of patients was 71.1. Of these patients, 53.7% had comorbid diseases and 51.2% revealed adenocarcinoma. The en bloc plus complete resection rate was 85.4%. Perforation during ESD occurred in 4.1% of the patients, and this was immediately closed with endoclips and then it was managed by conservative medical treatment. Bleeding occurred in 17.9% and there were no patients with severe bleeding. The en bloc plus complete resection rate and the complication rate for the elderly patients were not significantly different from those of the younger patients. Conclusions: The present study shows that ESD could be a safe and reliable treatment for gastric neoplasms in elderly patients.

Background/Aims: Elderly patients often have high operative risk due to their comorbid diseases, and the feasibility of performing endoscopic submucosal dissection (ESD) for such patients should be investigated. The aim of this study is to evaluate the efficacy and safety of performing ESD in elderly patients. Methods: From 2005 to 2007, 269 patients with gastric neoplasm were treated by ESD in our hospital. These patients were divided into the elderly patients who were 65 years of age or older and the younger patients. The number of enrolled elderly patients was 123. The en bloc complete resection rate and the complications were assessed and compared with those of the younger patients. Results: The average age of the old age group of patients was 71.1. Of these patients, 53.7% had comorbid diseases and 51.2% revealed adenocarcinoma. The en bloc plus complete resection rate was 85.4%. Perforation during ESD occurred in 4.1% of the patients, and this was immediately closed with endoclips and then it was managed by conservative medical treatment. Bleeding occurred in 17.9% and there were no patients with severe bleeding. The en bloc plus complete resection rate and the complication rate for the elderly patients were not significantly different from those of the younger patients. Conclusions: The present study shows that ESD could be a safe and reliable treatment for gastric neoplasms in elderly patients.

Elderly patient, Gastric neoplasm, Endoscopic submucosal dissection