Data support adoption of ESD
The current study was informative and will provide more support for adoption of colorectal ESD in the West, said Salmaan Jawaid, MD, of Baylor College of Medicine, Houston, in an interview.
Dr. Salmaan Jawaid
“Health economics in Asian countries are strikingly different than in other countries and support routine postprocedural admissions for observation,” Dr. Jawaid said. “Colorectal ESD has been slow to gain momentum in the West due to a steep learning curve, long procedural times, and the potential for complications with resultant hospital admissions. These logistical elements and impact on health care economics in the West serve as tremendous deterrents [of] adoption of colorectal ESD,” he explained.
“The current study demonstrates colorectal ESD, in a European health care system, may be feasible and safe in an outpatient setting, thereby effectively utilizing health care resources,” said Dr. Jawaid. “If admission after colorectal ESD is not routinely needed, health care systems may be more willing to support ESD on a broader scale with a consequent increase in surgery-saving procedures,” he noted.
Dr. Jawaid said he was not surprised by the findings overall. “However, I did find it interesting the number of patients who were safely discharged the same day after suffering colonic perforations,” he noted. He suspects improved methods of defect closure would explain this, and could in turn increase the rate of adoption.
“In experienced hands, I believe similar results will be attainable in a U.S.-based health care system,” he added.
However, “Validated protocol-based clinical pathways are needed in the West before widespread outpatient colorectal ESD is implemented. In the United States, emphasis should be made on the development of long-term educational systems whose primary goal is to ensure proper skills are acquired for endoscopic dissection,” he emphasized. “If support from a U.S. health care system is desired on a larger scale, detailed cost-benefit analyses are needed comparing all modalities of colon polyp removal.”
The study received no outside funding. The researchers had no financial conflicts to disclose. Dr. Jawaid disclosed serving as a consultant for Lumendi and Conmed.
This article was updated March 15, 2022.