期刊
GASTROINTESTINAL ENDOSCOPY
卷 97, 期 6, 页码 1045-1051出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.gie.2023.01.042
关键词
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Recent Western studies support the safety and efficacy of endoscopic submucosal dissection (ESD) for lesions throughout the GI tract. This study aimed to evaluate the safety and feasibility of same-day discharge (SDD) after ESD and factors associated with post-ESD admission.
Background and Aims: Recent Western studies support the safety and efficacy of endoscopic submucosal dissection (ESD) for lesions throughout the GI tract. Although admission for observation after ESD is standard in Asia, a more selective approach may optimize resource utilization. We aimed to evaluate the safety and feasi-bility of same-day discharge (SDD) after ESD and factors associated with admission. Methods: This was a post hoc analysis of a multicenter, prospective cohort of patients undergoing ESD (2016-2021). The primary end points were safety of SDD and factors associated with post-ESD admission. Results: Of 831 patients (median age, 67 years; 57% male) undergoing 831 ESDs (240 performed in the esoph-agus, 126 in the stomach, and 465 in the colorectum; median lesion size, 44 mm), 588 (71%) were SDD versus 243 (29%) admissions. Delayed bleeding and perforation occurred in 12 (2%) and 4 (.7%) of SDD patients, respec-tively; only 1 (.2%) required surgery. Of the 243 admissions, 223 (92%) were discharged after <24 hours of obser-vation. Interestingly, larger lesion size (>44 mm) was not associated with higher admission rate (odds ratio [OR], .5; 95% confidence interval [CI], .3-.8; P = .001). Lesions in the upper GI tract versus colon (OR, 1.7; 95% CI, 1.1-2.6; P = .01), invasive cancer (OR, 1.9; 95% CI, 1.2-3.1; P = .01), and adverse events (OR, 2.7; 95% CI, 1.5-4.8; P = .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 = .001) with procedure time >75 minutes (OR, 13.5; 95% CI, 8.5-21.3; P < .0001). Conclusions: SDD after ESD can be safe and feasible. Patients with invasive cancer, lesions in the upper GI tract, longer procedure times, or procedures performed by low-volume ESD endoscopists are more likely to be admitted postprocedure. Risk stratification of patients for SDD after ESD should help optimize resource utiliza-tion and enhance ESD uptake in the West. (Clinical trial registration number: NCT02989818.) (Gastrointest En-dosc 2023;97:1045-51.)
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