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

Abstract

Background and Aims

Endoscopic submucosal dissection (ESD) is increasingly used 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 postprocedure admission. As endoscopic closure of ESD wounds has improved, in 2022, we adopted an outpatient colorectal ESD protocol.

Methods

This study was a retrospective evaluation of adult patients who underwent colorectal ESD from January 2022 to April 2023. When technically feasible, the wound was closed by clips or suturing. After the procedure, patients were observed for up to 2 hours and discharged if they had no abdominal pain and no intraoperative muscle injury was present. We evaluated for operative success (en-bloc, R0, and curative resection) as well as safety (postprocedure pain, perforation, delayed bleeding).

Results

One hundred eleven lesions were removed by ESD in 105 consecutive patients. Nineteen lesions (17%) had prior EMR. All lesions were successfully removed: The en-bloc resection rate was 93% and the R0 and curative resection rate was 90%. Ninety-nine wounds (89%) were closed, most commonly using clips (60/111; 54%). Two small intraprocedural perforations occurred, 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 were 1 delayed bleed requiring hospitalization, 2 minor bleeds assessed at the emergency department, and 2 self-limited bleeds.

Conclusions

In this retrospective study, we demonstrated the feasibility of outpatient colorectal ESD. Among 105 patients, only 2 required hospital admission: 1 for postprocedure pain and 1 for delayed bleeding. We found that after endoscopic closure of ESD wounds, hospital admission was generally unnecessary and significant postprocedure bleeding was rare.