title: Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  One-day admission is sufficient in the absence of complications during ESD or early post-operative bleeding.
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Takaya
authors.initials: T
authors.lastname: Aoki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
authors.forename: Takahisa
authors.initials: T
authors.lastname: Matsuda
authors.forename: Taku
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Yassir
authors.initials: Y
authors.lastname: Khiyar
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000096:biosynthesis; D003106:Colon / Q000503:physiopathology*; D003108:Colonic Diseases / Q000628:therapy*; D003110:Colonic Neoplasms / Q000628:therapy; D003113:Colonoscopy / Q000379:methods* / Q000592:standards; D005260:Female; D005762:Gastroenterology / Q000592:standards; D006470:Hemorrhage; D006760:Hospitalization; D006801:Humans; D007249:Inflammation; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D002097:C-Reactive Protein