Claims-based frailty and short-term adverse events after esophageal or gastric endoscopic submucosal dissection in older adults

Abstract

Abstract Background Risk stratification before esophageal and gastric endoscopic submucosal dissection (ESD) in older adults often relies on age and comorbidity; however, these measures may not capture vulnerability reflected in routinely collected claims data. We aimed to evaluate the claims-based frailty and short-term adverse events association after esophageal and gastric endoscopic submucosal dissection. Methods We used a nationwide Japanese administrative database to identify patients aged ≥ 75 years who underwent first esophageal or gastric ESD. Frailty was defined using the Hospital Frailty Risk Score (HFRS), calculated from diagnoses during a 2 year lookback period. After 1:1 propensity score matching, frail and non-frail patients were compared. The primary outcome was binary composite of short-term adverse events, including in-hospital perforation/peritonitis, delayed bleeding, thromboembolism, aspiration pneumonia, and 30 day all-cause mortality. Component outcomes, survival, length of stay, costs, and readmission were also evaluated. Results Among 15,184 eligible patients, 4,970 matched pairs were included. Frailty was associated with the composite adverse outcome (adjusted odds ratio 1.35; 95% confidence interval 1.19–1.53), driven mainly by perforation/peritonitis and delayed bleeding. No significant differences were observed for 30 day mortality, thromboembolic events, or aspiration pneumonia. Frailty was also associated with lower overall survival during follow-up, whereas median length of stay was identical between groups. Conclusion Among older adults undergoing esophageal or gastric ESD, HFRS-defined claims-based frailty was associated with higher rates of short-term adverse events, particularly perforation/peritonitis and delayed bleeding. These findings suggest that routinely collected claims data may help identify vulnerable patients who warrant closer peri-procedural assessment and monitoring.

The authors' abstract, as published at the source. Journal of Gastroenterology, 2026 · DOI ↗