Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection

AIM： To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection （ESD）. METHODS： This is a retrospective observational study which included 189 patients consecutively treated by ESD at the National Cancer Center Hospital from May 2007 to March 2009. Patients were divided into 2 groups; patients in group A were discharged in 5 d and patients in group B included those who stayed longer than 5 d. The following data were collected for both groups： mean hospitalization period, tumor site, median tumor size, post-ESD rectal bleeding requiring urgent endoscopy, perforation during or after ESD, abdominal pain, fever above 38 ℃, and blood test results positive for inflammatory markers before and after ESD. Each parameter was compared after data collection. RESULTS： A total of 83% （156/189） of all patients could be discharged from the hospital on day 3 postESD. Complications were observed in 12.1% （23/189） of patients. Perforation occurred in 3.7% （7/189） of patients. All the perforations occurred during the ESD procedure and they were managed with endoscopic clipping. The incidence of post-operative bleeding was 2.6% （5/189）; all the cases involved rectal bleeding. We divided the subjects into 2 groups： tumor diameter ≥ 4 cm and 4 cm; there was no significant difference between the 2 groups （P = 0.93, χ 2 test with Yates correction）. The incidence of abdominal pain was 3.7% （7/189）. All the cases occurred on the day of the procedure or the next day. The median white blood cell count was 6800 ± 2280 （cells/μL; ± SD） for group A, and 7700 ± 2775 （cells/μL; ± SD） for group B, showing a statistically significant difference （P = 0.023, t-test）. The mean C-reactive protein values the day after ESD were 0.4 ± 1.3 mg/dL and 0.5 ± 1.3 mg/dL for groups A and B, respectively, with no significant difference between the 2 groups （P = 0.54, t -test）. CONCLUSION： One-day admission is sufficient in the absence of complications during ESD or early postoperative bleeding.