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WATCHFUL WAITING STRATEGY FOR HAEMATOCHEZIA AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION: A MULTICENTRE, PROSPECTIVE, SINGLE-ARM, VALIDATION STUDY

Takashi Kanesaka 1, Yoshito Hayashi 2, Shinjiro Yamaguchi 3, Ryotaro Uema 2, Hideharu Ogiyama 4, Takuya Yamada 5, Risato Takeda 6, Masashi Yamamoto 7, Akira Maekawa 8, Takashi Kizu 9, Akihiro Nishihara 10, Kengo Nagai 11, Shohei Ouchi 12, Shunsuke Yamamoto 13, Narihiro Shibukawa 14, Kenji Aoi 15, Keita Mori 16, Tetsuo Takehara 2

Affiliations

1 Osaka International Cancer Institute, Osaka, Japan|||Osaka University Graduate School of Medicine, Suita, Japan

2 Osaka University Graduate School of Medicine, Suita, Japan

3 Kansai Rosai Hospital, Amagasaki, Japan

4 Ikeda Municipal Hospital, Ikeda, Japan

5 Osaka Rosai Hospital, Sakai, Japan

6 Itami city hospital, Itami, Japan

7 Toyonaka Municipal Hospital, Toyonaka, Japan

8 Osaka Police Hospital, Osaka, Japan

9 Yao Municipal Hospital, Yao, Japan

10 Minoh City Hospital, Minoh City Hospital, Japan

11 Suita Municipal Hospital, Suita, Japan

12 Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan

13 National Hospital Organization Osaka National Center, Osaka, Japan

14 Sakai City Medical Center, Sakai, Japan

15 Kaizuka City Hospital, Kaizuka, Japan

16 Shizuoka Cancer Center, Nagaizumi-cho, Japan

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Abstract

Introduction

Haematochezia is a common adverse event after endoscopic submucosal dissection (ESD) of colorectal tumours, but the need for endoscopic intervention remain unclear.

Aims & Methods

This study aimed to verify the feasibility and safety of watchful waiting for the development of haematochezia after colorectal ESD. This multicentre, prospective, single-arm validation study was conducted at 15 hospitals in Japan. Patients planned to undergo colorectal ESD, ≥18 years of age, and with an Eastern Cooperative Group performance status of 0–1 were enrolled. Haematochezia was evaluated onsite for at least 48 hours after ESD and then managed according to a watchful waiting strategy (Table 1). The co-primary endpoints were the proportion of patients who avoided emergency colonoscopy and blood transfusion for haematochezia within 48 hours after ESD. The thresholds were set at 80% for emergency colonoscopy and 90% for blood transfusions.

Table 1. Watchful waiting strategy for haematochezia after colorectal ESD
ESD, endoscopic submucosal dissection
1. Conservative observation without endoscopic intervention is recommended for haematochezia within 48 hours after colorectal ESD if the following conditions are met: ・Mild hematochezia or up to 3 episodes of moderate/severe hematochezia, and ・Shock index (heart rate/systolic blood pressure) of <1. 2. Endoscopic intervention is considered for haematochezia >48 hours after colorectal ESD.

Results

Between May 2023 and December 2024, 515 patients were enrolled. ESD was performed in 482 patients, and haematochezia occurred in 121 patients within 48 hours after ESD. Emergent colonoscopy was avoided in 120 of 121 patients (99.2%; 95% confidence interval [CI], 95.5–100%), and blood transfusion was avoided in all 121 patients (100%; 95% CI, 97.0–100%). Of the 482 patients who underwent ESD, four (0.8%; 95% CI, 0.2–2.1%) underwent emergent colonoscopy, two (0.4%; 95% CI, 0.1–1.5%) required endoscopic haemostasis, and one received blood transfusion (0.2%; 95% CI, 0–1.2%), within 28 days after ESD.

Conclusion

Haematochezia after colorectal ESD can be safely observed with minimal endoscopic intervention by following a watchful waiting strategy when certain conditions are met.

Disclosure

Takashi Kanesaka received honoraria for lectures from Olympus Marketing, Inc. The other authors have no financial relationships to declare.

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Abstract

Session

Management of post-resection by endoscopy (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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