Published online Nov 7, 2022. doi: 10.3748/wjg.v28.i41.5957
Peer-review started: July 26, 2022
First decision: August 31, 2022
Revised: September 15, 2022
Accepted: October 19, 2022
Article in press: October 19, 2022
Published online: November 7, 2022
Processing time: 101 Days and 0.6 Hours
Endoscopic submucosal dissection (ESD) is an established technique for the treatment of early gastrointestinal neoplasia. Generally, a multi-day (M-D) admission is required for patients undergoing ESD due to potential complications. This retrospective study demonstrates that the same-day (S-D) discharge procedures for esophagogastric ESD may be feasible and effective.
ESD is safer, more cost-effective, has greater efficacy, and exhibits a positive impact on health-related quality of life in comparison with surgery. Reducing the length of hospital stay can decrease medical expenses, and some studies have attempted to shorten the duration of postprocedural hospitalization after esophageal, gastric, and colorectal ESD. However, data on the feasibility of S-D discharge after esophagogastric ESD remain limited.
In this study, we describe our preliminary experience with the S-D discharge strategy following ESD of the esophagus or stomach compared with conventional M-D hospital admission.
To minimize the effect of selection bias, the propensity score matching method was applied to balance the unevenly distributed patient baseline characteristics in this non-randomized trial. Subsequently, patients in the S-D and M-D groups were paired using the 1:1 nearest available score match algorithm with a match tolerance of 0.02. Further statistical analyses were conducted to compare the differences between the two groups based on the matched data.
No significant difference was found between the groups with respect to intraoperative and postprocedural major adverse events (AEs). The 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 to the M-D group.
This is the first retrospective study evaluating S-D discharge procedures for esophagogastric ESD in China. The result demonstrated the S-D discharge strategy may be feasible and effective for esophagogastric ESD, and the procedural-related AEs can be managed successfully.
This first retrospective study evaluating S-D discharge procedures for esophagogastric ESD in China demonstrates that this strategy may be feasible and effective, and that the AEs related to ESD could be managed successfully. Additional prospective studies are warranted to establish more detailed standards to select patients for S-D discharge ESD.