Colorectal ESD in day surgery

BACKGROUND: Colorectal endoscopic submucosal dissection (ESD) was developed in Japan and is growing in popularity in Europe. Patients undergoing a colorectal ESD procedure in Japan are hospitalized for several days. In this study, we investigated the feasibility of colorectal ESD as an outpatient procedure in a European setting. METHODS: A prospective cohort of all patients undergoing colorectal ESD at Danderyds Hospital, Stockholm, Sweden from April 2014 to December 2015 were studied. Data on patient demographics, procedural outcome and 30-day readmissions were studied. Data are presented as median (range), mean ± SD or true numbers as appropriate. RESULTS: A total of 182 patients underwent a colorectal ESD during the study period. Of the 182 these, 11 were scheduled for an in-hospital procedure and of 171 patients scheduled for a day-procedure and 15 were admitted for observation. The remaining 156 patients were discharged after 2–4 h of observation and comprise the study cohort. Mean age was 69 years. Median lesion size was 28 (10–120) mm, and median resection time was 65 (10–360) min. Lesions were located as follows: anal canal 1 (0.6%), rectum 52 (33.3%), sigmoid 17 (10.9%), descending 3 (1.9%), transverse 24 (15.4%), ascending 29 (18.6%), and cecum 30 (19.2%). Eight (5.1%) of the 156 day surgery patients returned for medical attention during the postoperative 30-day period. Three of them were admitted for in-hospital observation. None of the day surgery patients required any surgical intervention. CONCLUSION: Uncomplicated colorectal ESD can safely be carried out in a day surgery setting.