Introduction: Third space endoscopic procedures are becoming more widespread as a minimally invasive treatment alternative for patients. Often, patients are admitted overnight post-procedure to ensure adequate pain control, hydration, and monitoring for adverse events (AEs). There is limited data on the safety of same discharge on patients who have undergone third space procedures such as per-oral endoscopic myotomy (POEM), gastric per-oral endoscopic myotomy (GPOEM), zenkers per-oral endoscopic myotomy (ZPOEM), endoscopic submucosal dissection (ESD), and endoscopic full thickness resection (EFTR). This study evaluates the outcomes of same-day discharge after third space endoscopic procedures.
Methods: A retrospective chart review was performed at 6 centers on patients who underwent a third space endoscopic procedure followed by same-day discharge from June 2016 to October 2023. The primary outcomes were adverse event rate and readmission rate. Technical success was defined as completion of the intended procedure.
Results: Total of 175 patients were included in the study. The average age was 63 years. 70 (40%) were female and 105 (60%) were male. Thirty-seven (21%) patients underwent POEM, 11 (6%) underwent GPOEM, 7 (4%) underwent ZPOEM, 119 (68%) underwent ESD, and 1 underwent EFTR. Technical success was achieved in 93% (n=162): 100% in POEM, GPOEM, ZPOEM, EFTR; 89% (n=106) in ESD. Adverse events occurred in 5 (2.8%) patients. These included infection/abscess formation in 1 patient (post ESD requiring readmission), post-procedure bleeding in 2 patients (both post-ESD, 1 requiring repeat admission), mucosal tear treated periprocedurally (post-ESD), and a sore throat (post-POEM, requiring readmission). Readmission was required in 6 patients: 4 post-ESD and 2 post-POEM for a combined total of 6 days. 1 patient passed away 18 days post-procedure of unrelated etiology. Average follow-up was 379 days.
Conclusion: Same-day discharge after third space endoscopic procedures including POEM, GPOEM, ZPOEM, ESD, and EFTR is not associated with high rates of adverse events or readmission. Of the procedures, POEM and ESD had the highest likelihood of post-discharge readmission; consideration for overnight stay may be advisable in selected patients.

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Kelvin Liao

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