Low rate of general anaesthesia and hospital admission for SITE ESD of colonic Lateral Spreading Tumour

Aims Colonic ESD is recommended by western guidelines only in lesions at risk for early submucosal invasion also due to concerns over its safety profile and the need for general anaesthesia (GA) and hospital recover [1] [2]. In our centre we routinely perform saline immersion technique (SITE) ESD, with conscious sedation. The aim of this study was to demonstrate colonic ESD can be done without the need for GA or deep sedation.

Methods Consecutive patients referred to our hospital for colonic ESD have been retrieved from our prospective database. Baseline characteristics, technical data regarding ESD procedure and anaesthesia, operator-delivered conscious sedation were collected. Routine administration of a 5-day course of antibiotics, post ESD, was provided as per our unit protocol. Post ESD admission is not routinely applied in our centre, but reserved in case of complications, challenging cases, frail patients or patients living far from the hospital and therefore it was decided on a case-by-case basis.

Results A total of 116 patients were included in our analysis. Mean age was 67.0 years (SD11.3, range 39-88), 58.6% were men (n=68). Median ASA score was 2 (IQR 1-2;range 1-3). Lesion were resected respectively in the caecum (22 – 18.9%), ascending colon (33 – 28.4%), transverse colon (9 – 7.7%), descending colon (18 – 15.5%), sigmoid colon (34 – 29.3%). Median maximum size diameter was 40 mm (IQR 30-50). Median resection time was 120 min (IQR 75-165). 107 procedures out of 116 (93.0%) were performed under operator delivered conscious sedation, whereas 9 (7.0%) were done under GA. Median dose of Fentanyl was 137.5 mcg, (IQR 100-187.5, range 25-375) while median dose of midazolam was 5 mg (IQR 3.75-7.5, range 1-10). Forty-two out of 116 (36.2%) patients were admitted after the procedure for observation, median length of stay was 2 days (IQR 1-2, range 1-20), and 9/43 (11%) patients were admitted for more than 48 hrs. Only one 80-y-o patient with asbestosis (0.9%) experienced moderate respiratory failure in the recovery area after the procedure, which did not require invasive ventilation. The cause of this adverse event was not clearly established, although sedation was identified as a potential contributing factor. Multivariate analysis included age, ASA, complication, presence of fibrosis, area of the lesion, defect closure; age and resection time were the only risk factor for hospital admission at multivariate analysis (Age – OR 1.007, 95%CI 1.0002 – 1.015, 0.7% increased odds for every year, resection time – OR 1.017; 95%CI 1.002 – 1.033, 1.7% increased odds for every 10 min of procedure).

Conclusions Our results show that SITE-ESD in the colon does not requires GA, and only 7.7% of our patients needed a prolonged (> 48 hrs) post-ESD hospital stay. Decreasing resection time with drainage tubes and traction devices may further improve our outcomes. Further prospective studies collecting patients’ experience are warranted to reproduce our results.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Sidhu R, Turnbull D, Haboubi H, Leeds JS, Healey C, Hebbar S. et al. British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy. Gut 2023; 73: 219-45
• 2 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy 2022; 54: 591-622