We successfully treated a 97-year-old woman with a penetrating gastric ulcer by using nonsurgical means. We believe that patients with high operative risk should be treated conservatively. Thus, since oldest-old patients are at high risk for surgical treatment, the selection of a treatment strategy becomes a subject of discussion. From our experience in treating such cases, we believe that conservative treatment can be selected if the patient does not exhibit peritonitis symptoms such as muscular guarding and ascites. In an aging society, we think this experience is value.

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A 88-year-old woman was admitted to our hospital to receive a treatment for an early gastric cancer lesion with ulcerous change. Endoscopic ultrasonography(EUS)revealed that cancer invaded into the third layer of the stomach wall(submucosal layer). Considering the risk of the metastasis to lymph nodes, surgical treatment(D1+α dissection)was recommended. She was at relatively high risk using score system of estimation of physiologic ability and surgical stress, so she and her family refused surgical treatment. So, less invasive photodynamic therapy(PDT)was performed in Yamaguchi University Hospital. Endoscopic examination performed one year after PDT showed that the post PDT ulcer was scarred, and no signs of malignancy were seen by biopsy in the scarred lesion. As it is simple and safe, PDT can be used as an effective palliative therapy for aged patients who are out of curative indication of endoscopic mucosal resection and are relatively high risk of surgical treatment or reject it.

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