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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(03): E438-E442
DOI: 10.1055/a-1333-1736
Original article

Outpatient ESD for challenging colorectal lesions: Is it feasible and safe for western countries?

Silvia Pecere
1   Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
2   Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training – CERTT, Rome, Italy
,
Federico Barbaro
1   Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
2   Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training – CERTT, Rome, Italy
,
Lucio Petruzziello
1   Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
2   Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training – CERTT, Rome, Italy
,
Luigi Giovanni Papparella
1   Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
2   Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training – CERTT, Rome, Italy
,
Marco Napoli
1   Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
2   Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training – CERTT, Rome, Italy
,
Ivo Boskoski
1   Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
2   Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training – CERTT, Rome, Italy
,
Guido Costamagna
1   Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
2   Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training – CERTT, Rome, Italy
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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.



Publication History

Received: 06 July 2020

Accepted: 02 November 2020

Article published online:
19 February 2021

© 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/)

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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2021; 53(04): 458-458
DOI: 10.1055/a-1346-4865

 

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