Outpatient ESD for challenging colorectal lesions: Is it feasible and safe for western countries?
Open Access
- 18 February 2021
- journal article
- research article
- Published by Georg Thieme Verlag KG in Endoscopy International Open
- Vol. 09 (03), E438-E442
- https://doi.org/10.1055/a-1333-1736
Abstract
Background and study aims The need for hospital beds during the COVID-19 pandemic almost overwhelmed the health care systems all over the world. Therefore, elective non-life-saving procedures were postponed. We decided to perform all colorectal endoscopic mucosal dissections (ESDs) for challenging lesions as outpatient procedures, organizing an ad hoc path to management of any delayed post-procedural complications. The aim of the present study was to retrospectively evaluate the feasibility and safety of outpatient ESD for colorectal tumors. Patients and methods From March 2020 to May 2020, outpatient colorectal ESDs were performed for 15 challenging lesions. We retrospectively investigated feasibility and safety of the procedures, rates of en bloc resection, and complications rates. Results The mean age of the patients was 66.5 years and 40 % of the them were on antiplatelet/anticoagulation therapy. Median size of removed lesions was 45 mm (range 32–77) and 38 mm (range 24 to 55) Five patients (33 %) had rectal tumors extending to the dentate line and four (26.6 %) were recurrences on a scar of previous endoscopic or surgical local resections. All complications, such as bleeding or visible microperforation, were managed endoscopically and no delayed perforations occurred. One patient had fever (37.5 °C), while three patients complained of anal pain after ESD for a rectal tumor that extended to the dentate line (RTDL); all patients were managed conservatively. Conclusion Outpatient colorectal ESD is feasible and safe for challenging lesions. It reduces costs of hospitalization but direct access to the endoscopy service to manage potential post-ESD complications should always be guaranteed. Received: 06 July 2020 Accepted: 02 November 2020 Publication Date: 19 February 2021 (online) © 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyThis publication has 16 references indexed in Scilit:
- Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factorsGut, 2016
- Prediction model and risk score for perforation in patients undergoing colorectal endoscopic submucosal dissectionGastrointestinal Endoscopy, 2015
- JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resectionDigestive Endoscopy, 2015
- Colorectal endoscopic submucosal dissection: Recent technical advances for safe and successful proceduresWorld Journal of Gastrointestinal Endoscopy, 2015
- Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesionsGastrointestinal Endoscopy, 2013
- New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video)Gastrointestinal Endoscopy, 2012
- A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video)Gastrointestinal Endoscopy, 2010
- Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforationEndoscopy, 2009
- The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002Gastrointestinal Endoscopy, 2003
- Circumferential EMR of carcinoma arising in Barrett's esophagus: case reportGastrointestinal Endoscopy, 2003