71% of U.S. ESD Patients in Study Were Discharged Without Hospital Admission
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71% of U.S. ESD Patients in Study Were Discharged Without Hospital Admission

Douglas K. Rex, MD, MASGE, reviewing King W, et al. Gastrointest Endosc 2023 Jan 29.

Endoscopic submucosal dissection (ESD) is frequently followed by hospital admission for multiple days in Asian countries. However, hospitalization is much more expensive in the U.S., and routine hospitalization diminishes the relative cost-effectiveness of ESD. Increasingly, U.S. endoscopists who perform submucosal endoscopy are willing to allow patients to be released after procedures.

In a cohort study of 9 expert U.S. centers, 831 patients underwent ESD, including 56% colorectal, 29% esophagus, and 15% stomach. The median lesion size was 44 mm, and the median total procedure time was 76 minutes.

Overall, 70.8% of patients underwent same-day discharge, and 29.2% were admitted, though 92% of admitted patients were hospitalized for less than 24 hours. The overall delayed hemorrhage rate was 2%, and the delayed perforation rate was 0.7%, but only 1 patient required surgery.

Admitted patients were more likely than patients discharged after the procedure to meet American Society of Anesthesiologists class IV criteria (7% vs 1%) and have upper GI lesions (20% vs 11%), invasive cancer (26% vs 13%), a longer procedure time (136 vs 69 minutes), and ESD performed by a low-volume endoscopist (defined as <50 cases; 33% vs 16%). Neither larger polyp size nor submucosal fibrosis was associated with hospitalization.

Douglas K. Rex, MD, FASGE

COMMENT

This hospitalization rate after ESD is much higher than the expected rate for endoscopic mucosal resection. However, an outpatient ESD rate of 71% is a significant achievement and an important direction for ESD in the U.S. These data indicate that doctors early in their ESD experience will have higher patient hospitalization rates, a not unexpected result.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

King W, Draganov P, Gorrepati VS, et al. Safety and feasibility of same-day discharge after endoscopic submucosal dissection: a Western multicenter prospective cohort study. Gastrointest Endosc 2023 Jan 29. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2023.01.042)

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