Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection.


BACKGROUND AND AIM Colorectal endoscopic submucosal dissection (ESD) is a useful treatment method; however, no index has been established for time for patient to start food ingestion or be discharged after ESD. We investigated the potential of a clinical pathway in which patients started food ingestion on day 2 after ESD and were discharged on day 3. METHODS A total of 382 patients underwent colorectal ESD between 2006 and 2012. A flow chart of a clinical pathway was prepared based on the data obtained, with the aim of shortening hospital stay after ESD. RESULTS Mean duration of postoperative hospital stay in the 382 patients was 5.3 ± 1.8 days. The most common cause of extended hospital stay was abnormal blood test finding, as detected in 50 patients in group C (n = 131; 38.2%), followed by careful course observations, as noted in 48 patients in group C (n = 131; 36.6%). Regarding procedural accidents as a result of ESD, intraoperative perforation occurred in 15 patients (3.9%) and post-ESD bleeding in seven patients (1.8%), which extended the hospital stay. Food ingestion was started on day 2 when no abnormality was noted during ESD or in physical and imaging findings or blood tests on day 1. In the 86 patients who underwent the prepared clinical pathway as a validation study, 68 (79.0%) were discharged on day 3. Duration of postoperative hospital stay was 3.4 ± 1.2 days. CONCLUSION Discharge may be possible 3 days after ESD when no abnormalities are noted during ESD or on post-ESD day 1.

DOI: 10.1111/den.12468
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@article{Tomiki2015ClinicalPT, title={Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection.}, author={Yuichi Tomiki and Masaya Kawai and Kazuhiro Takehara and Yoshihiko Tashiro and Shinya Munakata and Kazumasa Kure and Shun Ishiyama and Kiichi Sugimoto and Hirohiko Kamiyama and Makoto Takahashi and Kazuhiro Sakamoto}, journal={Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society}, year={2015}, volume={27 6}, pages={679-86} }