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Safety and Feasibility of Same-Day Discharge After Endoscopic Submucosal Dissection: A Western Multicenter Prospective Cohort Study

Published:January 29, 2023DOI:https://doi.org/10.1016/j.gie.2023.01.042
Safety and Feasibility of Same-Day Discharge After Endoscopic Submucosal Dissection: A Western Multicenter Prospective Cohort Study
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      ABSTRACT

      Backgrounds and Aims

      Recent Western studies support the safety and efficacy of endoscopic submucosal dissection (ESD) for lesions throughout the GI tract. While admission for observation after ESD is standard in Asia, a more selective approach may optimize resource utilization. We aim to evaluate the safety and feasibility of same-day discharge (SDD) after ESD and factors associated with admission.

      Methods

      Post-hoc analysis of a multicenter prospective cohort of patients undergoing ESD (2016 to 2021). Primary end points were safety of SDD and factors associated with post-ESD admission.

      Results

      Of 831 patients (median 67 years, 57% men) undergoing 831 ESD (240 esophagus, 126 stomach, 465 colorectum; median size 44 mm), 588(71%) were SDD versus 243(29%). Delayed bleeding and perforation occurred in 12(2%) and 4(0.7%) of SDD patients, respectively; with only 1(0.2%) requiring surgery. Out of the 243 admissions, 223(92%) were discharged ≤24 hours of observation. Interestingly, larger lesion size (>44 mm) was not associated with higher admission rate (OR: 0.5,95%CI:0.3-0.8;p=0.001). Lesions in the upper GI tract versus colon (OR:1.7;95%CI:1.1-2.6,p=0.01), invasive cancer(OR:1.9;95%CI:1.2-3.1,p=0.01), adverse events(OR:2.7;95%CI:1.5-4.8,p=0.001) were independent factors for admission. Admissions were more likely performed by endoscopists with ESD volume <50 cases(OR:2.1;95%CI:1.3-3.3,p=0.001) with procedure time >75 minutes(OR:13.5;95%CI:8.5-21.3,p<0.0001).

      Conclusion

      SDD after ESD can be safe and feasible. Invasive cancer, lesions in the upper GI tract, those associated with longer procedure or performed by low ESD volume endoscopists are more likely to be admitted post-procedurally. Risk stratification of patients for SDD after ESD should help optimize resource utilization and enhance ESD uptake in the West.

      ACRONYMS:

      ESD (Endoscopic submucosal dissection), EMR (endoscopic mucosal resection), SD (standard deviation), SDD (Same day discharge), IQR (Interquartile range), OR (Odds ratio), CI (Confidence interval), GI (Gastrointestinal), EMR (Endoscopic mucosal resection), ASA (American Society of Anesthesiologists), GEJ (Gastroesophageal junction), HGD (High grade dysplasia), LGD (Low grade dysplasia)
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      Article info

      Publication history

      Accepted: January 22, 2023
      Received in revised form: November 5, 2022
      Received: August 2, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Authors Contributions: William King MD, V Subhash Gorrepati MD, Peter Draganov MD, and Dennis Yang MD participated in the analysis and interpretation of the data and drafting of the article. All authors participated in the conception and design, collection of study data, critical revision of the article for important intellectual content, and final approval of the article.

      Conflicts of Interest:

      PV Draganov is a consultant for Boston Scientific, Olympus America, Cook Medical, and Fujifilm. D Yang is a consultant for Olympus, Fujifilm, Apollo Endosurgery, Medtronic, and Microtech. S Ngamruengphong is a consultant for Boston Scientific. BJ Elmunzer is a consultant for Takeda Pharmaceuticals. H Aihara is a consultant for Boston Scientific, Olympus America, Fujifilm, Medtronic, Auris Health, Lumendi and 3-D Matrix. NR Sharma is a consultant for Boston Scientific, Steris, Mauna Kea, and Medtronic and serves on the advisory board for Endoscopynow. IS Grimm is a consultant for Boston Scientific. AA Aadam is a consultant for Boston Scientific and Steris Endoscopy. MO Othman is a consultant for Abbvie, Olympus, Lumendi, ConMed, and Boston Scientific. All other authors have nothing to disclose.

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.01.042

      Copyright

      © 2023 by the American Society for Gastrointestinal Endoscopy

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