Evaluation of the safety and feasibility of outpatient colorectal endoscopic submucosal dissection

Abstract

Background and AimsEndoscopic submucosal dissection (ESD) is increasingly utilized for resection of benign nonpedunculated colorectal polyps and early cancers. However, there is concern that adoption of ESD may be limited by increased resource utilization with routine post-procedure admission. As endoscopic closure of ESD wounds has improved, in 2022 we adopted an outpatient colorectal ESD protocol. MethodsThis study was a retrospective evaluation of adult patients that underwent colorectal ESD from 1/2022 to 4/2023. When technically feasible, the wound was closed by clips or suturing. Following the procedure, patients were observed for up to 2 hours and discharged if they had no abdominal pain and there was no intra-operative muscle injury. We evaluated for operative success (en bloc resection, R0 and curative resection) as well as safety (post-procedure pain, perforation, delayed bleeding). ResultsA total of 111 lesions were removed by ESD in 105 consecutive patients. 19/111 (17%) had prior endoscopic mucosal resection. All lesions were successfully removed: en bloc resection rate was 93%, R0 and curative resection rate was 90%. 99/111 (89%) of the wounds were closed, most commonly using clips (60/111; 54%). There were two small intraprocedural perforations, both managed with clip closure and the patients did not require admission. Among patients with defect closure, there were no delayed bleeds requiring hospitalization and only 1 episode of self-limited bleeding. In contrast, among 12 patients with resection sites not amenable to closure, there was 1 delayed bleed requiring hospitalization, 2 minor bleeds assessed at the emergency department and 2 self-limited bleeds. ConclusionsIn this retrospective study we demonstrate the feasibility of outpatient colorectal ESD. Among 105 patients, only 2 required hospital admission: one for post-procedure pain and one for delayed bleeding. We find that after endoscopic closure of ESD wounds, hospital admission is generally unnecessary and significant post-procedure bleeding is rare.