Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

Abstract

BACKGROUND Endoscopic submucosal dissection (ESD) is an established technique for the treatment of early gastrointestinal neoplasia. Generally, multi-day (M-D) admission is required for patients undergoing ESD due to potential complications. AIM To evaluate the feasibility of a same-day (S-D) discharge strategy for ESD of the esophagus or stomach. METHODS The data of patients who underwent esophageal or gastric ESD were retrospectively collected from January 2018 to December 2021 at Peking University Cancer Hospital. The propensity score matching (PSM) method was applied to balance the unevenly distributed patient baseline characteristics between the S-D and M-D groups. Intraoperative and postoperative parameters were compared between the matched groups. RESULTS Among the 479 patients reviewed, 470 patients, including 91 in the S-D group and 379 in the M-D group, fulfilled the inclusion and exclusion criteria. Following PSM, 78 patients in each group were paired using the 1:1 nearest available score match algorithm. No significant difference was found between groups with respect to intraoperative and postprocedural major adverse events (AEs). Tumor size, complete resection rate, and procedural duration were comparable between the groups. The S-D group demonstrated a significantly shorter length of hospital stay ( P < 0.001) and lower overall medical expenses ( P < 0.001) compared with the M-D group. CONCLUSION The S-D discharge strategy may be feasible and effective for esophagogastric ESD, and the procedural-related AEs can be managed successfully.

Early gastric cancer recurrence after endoscopic submucosal dissection: Not to be ignored!

“…Early gastric cancer (EGC) is defined as gastric cancer (GC) confined to the mucosa or submucosa with or without nodal involvement[ 1 ]. Endoscopic submucosal dissection (ESD) is considered an effective treatment for EGC and is recommended worldwide due to its safer and more cost-effective advantages[ 2 ]. Although the recurrence rate after ESD for EGC is relatively low, the problem of post-ESD recurrence in EGC patients has grasped momentous attention in recent years due to the popularization of ESD technology and the increase of post-ESD patients worldwide.…”