32 - Safety and Feasibility of Same-Day Discharge After Endoscopic Submucosal Dissection: A Western Multicenter Prospective Cohort Study

Tuesday, October 25, 2022

9:10 AM – 9:20 AM ET

Location: Hall C1

Presenting Author(s)

William W. King, MD

University of Florida
Gainesville, FL

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William W. King, MD¹, Subhash Gorrepati, MD¹, Peter Draganov, MD¹, Dennis Yang, MD²
¹University of Florida, Gainesville, FL; ²Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, FL

Introduction: Patients undergoing endoscopic submucosal dissection (ESD) in Asia are traditionally admitted for routine post-procedural observation. Data on the feasibility of same-day discharge (SDD) following ESD remains scarce. We aimed to evaluate the safety and feasibility of SDD after ESD and to identify factors associated with admission.

Methods: Retrospective post-hoc analysis of multicenter prospective cohort study of adults who underwent ESD at 10 participating centers from 2016 to 2021. The primary endpoint was safety and feasibility of SDD after ESD and to identify factors associated with admission. Endoscopists with < 50 cases were defined as low-volume ESD endoscopists. Lesions with Paris 0-IIc or III were considered to have a depressed morphology component.

Results: 831 patients (57% male, median age 67 [IQR 57-74]) underwent esophageal (n=240), gastric (n=126), and colorectal (n=465) ESD, of which 588 (71%) underwent SDD and 243 (29%) were admitted. 13 (2%) in the SDD group had delayed bleeding, 9 requiring repeat endoscopy and 2 needing blood transfusion. Four patients (1%) had delayed perforation, of which only one required surgery. Out of the 243 admissions, 223 (92%) were discharged within 24 hours after routine post-procedural observation. Nineteen patients (8%) were admitted for the management of adverse events: 3 for bleeding and 16 for intraprocedural perforation. All these complications were managed endoscopically, and none required surgery. Mean hospital length of stay was 1.3±0.8 days. Interestingly, on multivariate analysis, lesion size ≥45 mm inversely correlated with admission (OR: 0.5; 95% CI: 0.3-0.8; P=0.001). All of the following factors were independently associated with a higher likelihood of admission: ESD in esophagus/stomach vs colorectal (OR: 1.7; 95% CI: 1.1-2.6; P=0.011), low endoscopist volume (OR: 2.1; 95% CI: 1.3-3.3; P=0.001), invasive cancer histology at baseline (OR: 1.9; 95% CI: 1.2-3.1; P=0.010), adverse events (OR: 2.7; 95% CI: 1.5-4.8; P=0.001), and procedure time >75 minutes (OR: 13.5; 95% CI 8.5-21.3; P< 0.001).

Discussion: SDD is feasible and safe, with less than 3% of patients developing delayed adverse events following SDD. Factors including ESD location, lesion size, baseline histology, endoscopist volume, and procedural time appear to correlate with need for admission. Additional studies are needed to identify predictors for SDD after ESD.

Baseline Characteristic	All (N=278)	Admitted (N=105)	Discharged (N=173)	P-value
Age ± SD	66.5 ± 9.6	67.4 ± 10.4	67.1 ± 10.1	0.407
Male	188 (68%)	69 (66%)	119 (69%)	0.597
Procedure time ± SD	93.6 ± 62.0	124.6 ± 69.4	75.0 ± 48.5	< 0.00001
ASA class I II III IV	13 (5%) 90 (23%) 160 (58%) 15 (5%)	1 (1%) 27 (26%) 65 (62%) 12 (11%)	12 (7%) 63 (36%) 95 (55%) 3 (2%)	0.005
Location Esophagus Stomach	176 (63%) 102 (37%)	70 (67%) 35 (33%)	106 (61%) 67 (39%)	0.365
Prior intervention	73 (26%)	21 (20%)	52 (30%)	0.065
No fibrosis Submucosal fibrosis Mild Moderate Severe	171 (62%) 107 (38%) 37 (13%) 31 (11%) 40 (14%)	75 (71%) 30 (29%) 8 (8%) 6 (6%) 17 (16%)	96 (45%) 77 (55%) 29 (17%) 25 (14%) 23 (13%)	0.008
Size ± SD	47.5 ± 23.8	47.1 ± 24.0	48.0 ± 23.8	0.516
Depressed Non-depressed Flat/sessile Elevated Mixed Other	58 (21%) 220 (79%) 113 (41%) 82 (29%) 5 (2%) 15 (5%)	23 (22%) 82 (78%) 34 (32%) 40 (38%) 2 (2%) 2 (2%)	35 (20%) 138 (80%) 79 (46%) 42 (24%) 3 (2%) 13 (8%)	0.740
Invasive cancer Non-invasive Intramucosal carcinoma HGD LGD Other	80 (29%) 198 (71%) 81 (29%) 44 (16%) 22 (8%) 44 (16%)	43 (41%) 62 (59%) 28 (27%) 11 (10%) 5 (5%) 15 (14%)	37 (21%) 136 (79%) 53 (31%) 33 (19%) 17 (10%) 29 (17%)	0.0004
En bloc resection	272 (98%)	103 (98%)	169 (98%)	1
R0 resection	237 (85%)	82 (78%)	155 (90%)	0.009
Curative resection	208 (75%)	69 (66%)	139 (80%)	0.006
Endoscopist volume < 50	72 (26%)	42 (40%)	30 (17%)	< 0.00001

Table: Baseline characteristics of patients hospitalized and discharged following endoscopic submucosal dissection for upper GI lesions. SD=Standard deviation. ASA=American Society of Anesthesiologists. GEJ=Gastroesophageal junction. HGD=High grade dysplasia. LGD=Low grade dysplasia.

Disclosures:

William King indicated no relevant financial relationships.

Subhash Gorrepati indicated no relevant financial relationships.

Peter Draganov: Boston Scientific – Consultant. Cook Medical – Consultant. Fujifilm – Consultant. Lumendi – Consultant. Merit – Consultant. Mirotech – Consultant. Olympus America – Consultant. Steris – Consultant.

Dennis Yang: Apollo Endosurgery – Consultant. Fujifilm – Consultant. Medtronic – Consultant. Microtech – Consultant. Olympus – Consultant.

William W. King, MD¹, Subhash Gorrepati, MD¹, Peter Draganov, MD¹, Dennis Yang, MD², 32, Safety and Feasibility of Same-Day Discharge After Endoscopic Submucosal Dissection: A Western Multicenter Prospective Cohort Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.