Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Surg Endosc. 2017 Sep;31(9):3690-3695. doi: 10.1007/s00464-016-5407-7. Epub 2017 Feb 8.
Colorectal endoscopic submucosal dissection (ESD) was developed in Japan and is growing in popularity in Europe. Patients undergoing a colorectal ESD procedure in Japan are hospitalized for several days. In this study, we investigated the feasibility of colorectal ESD as an outpatient procedure in a European setting.
A prospective cohort of all patients undergoing colorectal ESD at Danderyds Hospital, Stockholm, Sweden from April 2014 to December 2015 were studied. Data on patient demographics, procedural outcome and 30-day readmissions were studied. Data are presented as median (range), mean ± SD or true numbers as appropriate.
A total of 182 patients underwent a colorectal ESD during the study period. Of the 182 these, 11 were scheduled for an in-hospital procedure and of 171 patients scheduled for a day-procedure and 15 were admitted for observation. The remaining 156 patients were discharged after 2-4 h of observation and comprise the study cohort. Mean age was 69 years. Median lesion size was 28 (10-120) mm, and median resection time was 65 (10-360) min. Lesions were located as follows: anal canal 1 (0.6%), rectum 52 (33.3%), sigmoid 17 (10.9%), descending 3 (1.9%), transverse 24 (15.4%), ascending 29 (18.6%), and cecum 30 (19.2%). Eight (5.1%) of the 156 day surgery patients returned for medical attention during the postoperative 30-day period. Three of them were admitted for in-hospital observation. None of the day surgery patients required any surgical intervention.
Uncomplicated colorectal ESD can safely be carried out in a day surgery setting.
结直肠内镜黏膜下剥离术（ESD）最初在日本发展，目前在欧洲越来越受欢迎。在日本接受结直肠 ESD 手术的患者需要住院数天。本研究旨在探讨在欧洲环境下将结直肠 ESD 作为门诊手术的可行性。
对 2014 年 4 月至 2015 年 12 月期间在瑞典斯德哥尔摩 Danderyds 医院接受结直肠 ESD 的所有患者进行前瞻性队列研究。研究了患者的人口统计学资料、手术结果和 30 天再入院情况。数据以中位数（范围）、均值 ± 标准差或实际数字表示。
研究期间共有 182 例患者接受了结直肠 ESD。其中 11 例患者计划住院手术，171 例患者计划日间手术，15 例患者住院观察。其余 156 例患者观察 2-4 小时后出院，为研究队列。患者平均年龄为 69 岁。中位病变大小为 28（10-120）mm，中位切除时间为 65（10-360）min。病变部位如下：肛管 1 例（0.6%），直肠 52 例（33.3%），乙状结肠 17 例（10.9%），降结肠 3 例（1.9%），横结肠 24 例（15.4%），升结肠 29 例（18.6%），盲肠 30 例（19.2%）。在术后 30 天内，有 8 例（5.1%）日间手术患者因医疗需要返回。其中 3 例住院观察。无日间手术患者需要任何手术干预。
结直肠 ESD 术如果没有并发症，可以安全地在日间手术环境下进行。
