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Background: Endoscopic submucosal dissection (ESD) has the advantage of permitting en bloc and histologically complete resection for early gastric cancer. Elderly patients often have surgical operative risks due to disease, and the feasibility of this treatment for such patients will improve the quality of life. The aim of the present study is to evaluate the efficacy and safety of ESD in elderly patients. Methods: We reviewed patients who underwent ESD for gastric lesions at Maebashi Red Cross Hospital. Among 251 gastric lesions treated by ESD from 2002 to 2006, 110 lesions were discovered in 93 elderly patients who were 75 years of age or older. The one-piece resection with tumor-free margin rate and the complications were assessed in comparison with younger patients under 75 years old. Results: The average age of the elderly patients was 79.8 years (range 75–92 years). The one-piece resection with tumor-free margin rate was 96.4% (106/110). Immediate bleeding occurred in one lesion (0.9%) and delayed bleeding requiring emergency endoscopy occurred in five lesions (4.5%). Perforation during ESD occurred in two patients (1.8%), and was immediately closed with endoclips and managed by conservative medical treatment. One case (0.9%) complicated with delayed perforation was managed by conservative medical treatment. The one-piece resection with tumor-free margin rate and the complication rate in elderly patients were not significantly different from those of younger patients. Conclusion: The present study shows the technical feasibility of ESD for gastric neoplasms in elderly patients. [ABSTRACT FROM AUTHOR]