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Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection
Author(s) -
Tomiki Yuichi,
Kawai Masaya,
Takehara Kazuhiro,
Tashiro Yoshihiko,
Munakata Shinya,
Kure Kazumasa,
Ishiyama Shun,
Sugimoto Kiichi,
Kamiyama Hirohiko,
Takahashi Makoto,
Sakamoto Kazuhiro
Publication year - 2015
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12468
Subject(s) - medicine , endoscopic submucosal dissection , perforation , ingestion , surgery , colonoscopy , endoscopy , colorectal cancer , materials science , punching , cancer , metallurgy
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.