Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 28, 2012; 18(28): 3721-3726
Published online Jul 28, 2012. doi: 10.3748/wjg.v18.i28.3721
Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection
Takaya Aoki, Takeshi Nakajima, Yutaka Saito, Takahisa Matsuda, Taku Sakamoto, Takao Itoi, Yassir Khiyar, Fuminori Moriyasu
Takaya Aoki, Takeshi Nakajima, Yutaka Saito, Takahisa Matsuda, Taku Sakamoto, Yassir Khiyar, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Takaya Aoki, Takao Itoi, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan
Author contributions: Aoki T, Nakajima T, Saito Y, Matsuda T and Sakamoto T designed the research study; Aoki T, Nakajima T, Saito Y, Matsuda T, Sakamoto T, Itoi T and Moriyasu F contributed new reagents/analytic tools; Aoki T, Nakajima T and Saito Y analyzed the data; Aoki T, Nakajima T, Saito Y and Khiyar Y wrote the paper.
Supported by Grant-in-Aid for Cancer Research, No. 18S-2 from the Japanese Ministry of Health, Labor and Welfare to Saito Y
Correspondence to: Yutaka Saito, MD, PhD, Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. ytsaito@ncc.go.jp
Telephone: +81-3-35422511 Fax: +81-3-35423815
Received: November 22, 2011
Revised: April 12, 2012
Accepted: May 5, 2012
Published online: July 28, 2012
Abstract

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  °C, 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 post-ESD. 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, χ2 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 post-operative bleeding.

Keywords: Clinical pathway, Colon, Complication, Endoscopic submucosal dissection, Hospitalization period, Rectum