Length of Stay for Double Balloon Interventional Platform Assisted ESD vs Conventional ESD: A Comparative Analysis

Introduction: Endoscopic Submucosal Dissection (ESD) has rapidly emerged as a widely acceptable platform for complex colon lesions. Widespread use of ESD in colon is limited by lack of expertise, prolonged procedure times, lack of scope stability and difficulty with traction impairing mucosal visualization. The Double balloon (DBA)endoluminal interventional platform (DiLumen, Lumendi LLC, CT USA) has been shown to improve procedure time as compared to conventional ESD. We performed a comparative analysis of length of stay in patients undergoing ESD with double balloon platform (DiLumen) vs conventional ESD to assess whether use of such device is associated with decrease lenght of stay. Methods: This was a single center IRB approved study in which we evaluated patients who underwent conventional ESD between 1/2016 to 12/2017 (119 consecutive patients) and compared them prospectively to patients who underwent DBA-ESD between 1/2018-3/2020 (79 consecutive patients). Subsequently, propensity score matching was done for age, gender, lesion area (cm2), difficult location, and prior lesion manipulation (tattoo, argon plasma, EMR)/fibrosis) to reduce statistical bias. After propensity matching there were 45 patients left in each group. Results: Mean age of patients in DBA assisted ESD group was 66.0 ± 10.97 vs 63.8 ± 9.58 in conventional ESD group (p=0.12). Mean overall length of stay was 1.36 days in DBA-ESD group while that in conventional C-ESD group was 2.07 days (p < 0.008). Same day discharge was possible in 43% cases in DBA-ESD (N=79) and only 16% cases in C-ESD (N=117) group (p=0.00005). After propensity matching, mean length of stay was 1.22 ± 1.74 days in DBA-ESD group vs 1.82 ± 1.63 days in conventional ESD group (p=0.039). Same day discharge after propensity matching was possible in 17 (38%) cases in DBA-ESD group vs 9 (20%) in C-ESD group (p=0.016). Conclusion: Our results show that the novel DBA assisted ESD is associated with reduced length of hospital stay as compared to conventional ESD. Patients in DBA-ESD group even after propensity matching had 33% decrease in length of hospital stay. The rate of same day discharge was almost two times higher in DBA assisted ESD as compared to conventional ESD group even after propensity matching. This decrease length of stay is likely related to ability of DiLumen to improve traction, stability and mucosal visualization leading to improve ability to close the defect via suturing. Further multicenter studies are needed to draw concrete conclusions.Table 1.: Characteristics of matched patient population. Difficult location was defined as appendiceal orifice, cecum, IC valve, hepatic or splenic flexure, sigmoid colon.