Endoscopic submucosal dissection of gastrointestinal lesions on an outpatient basis

Abstract

Background: Endoscopic submucosal dissection (ESD) is usually associated with hospital admission. Objectives: To evaluate, prospectively, the feasibility, safety and efficacy of outpatient gastrointestinal ESD. Methods: Patients with suitable lesions were invited to participate. Those that dwelt more than 1 hour from the hospital, lived alone, had severe co-morbidities, were <18 years old, had duodenal lesions, or that had ESD-related complications were admitted. The remaining patients were discharged if no complications were detected. A patients' inquiry was performed.Results: Of the 164 ESD patients, 122 were outpatient-based, corresponding to 115 patients, 47% male and mean age 63 AE 12 years-old. Outpatients tended to be younger, female, to have gastric lesions, less advanced lesions, and shorter and less complicated ESDs (all p < 0.05). Outpatients' mean tumour size was 38 mm, en bloc and R0 resection rates were 88 and 78%, respectively. Seven ESD outpatients (5.7%) had complications: delayed bleeding (n ¼ 4), pneumonitis (n ¼ 2) or emphysema (n ¼ 1), all managed conservatively. Colorectal location of the lesions was predictive of hospital admission (p ¼ 0.03). In total, 97% of patients were satisfied with the outpatient strategy. Conclusion: Risks of ambulatory ESD are low and complications can be successfully managed. This strategy has high patient satisfaction. More studies are needed to evaluate its implications on costs and patients' management.

Wide-field endoscopic submucosal dissection for the treatment of Barrett’s esophagus neoplasia

“…Higher costs of ESD, mainly associated with longer hospital admission, have also hampered its use in BE. However, it was recently demonstrated that ESD can be safely performed in an outpatient setting, reducing costs and hospitalization risks [13].…”

Setting the stage for research in endoscopy

“…This highlights the importance of endoscopy in gastroenterology mentioned above. You will find manuscripts on new developments relevant for endoscopic detection of early neoplastic lesions; 4 learn something about the endoscopic treatment of such lesions; 5 get information on new tools for endoscopic treatment; 6 and become aware of the usefulness of standard techniques, and how and when they are applied 7 . Hence, there should be something for everyone.…”

Endoscopic submucosal dissection on an outpatient basis

“…I read with great interest the paper by Baldaque-Silva et al entitled 'Endoscopic submucosal dissection of gastrointestinal lesions on an outpatient basis'. 1 The Gastroenterology Department of Centro Hospitalar S. Joa˜o, in Porto, Portugal, has one of the largest published endoscopic submucosal dissection (ESD) series in the Western setting. 2 Baldaque-Silva was the first in Portugal to perform outpatient-based ESD, and his manuscript 1 reports the initial experience of this strategy, analysing ESDs that were executed until 2013 (n ¼ 164, of which 122 were outpatient based).…”

“…I read with great interest the paper by Baldaque‐Silva et al. entitled ‘Endoscopic submucosal dissection of gastrointestinal lesions on an outpatient basis’ 1 …”

“…Since the end of that study 1 until May 2019, 301 additional ESDs have been performed in the same department by a different endoscopy team (JSA and MM). These procedures were consecutively recorded in an electronic database and have now been retrospectively assessed.…”