There is no consensus on whether routine hospital admission is required following colorectal ESD, and practice varies internationally. At our institution, patients are typically admitted overnight for observation. We aimed to evaluate post ESD outcomes to identify factors that may guide decision-making on the need for hospital admission. 

We conducted a retrospective study of patients undergoing colorectal ESD between October 2019 to October 2025 at a tertiary centre in the United Kingdom. Data were obtained from electronic records. Categorical variables were compared using the Chi-square test, and continuous variables using the T-test or Mann–Whitney U test based on distribution. All procedures were performed using a bipolar radiofrequency/high-frequency microwave device (Speedboat™). Procedural complications—defined as perforation, bleeding or post-polypectomy syndrome related to ESD—were classified as immediate (≤24 hours) or  delayed (>24 hours). Patients were grouped into uncomplicated and complicated ESD.

A total of 225 patients were included; 204 (91%) were discharged within 24 hours. Extended hospitalisation occurred in 21 patients. Of these, 10 cases (48%) were due to immediate procedural complications, 7 (33%) were due to procedure-dependent symptoms such as abdominal pain or raised inflammatory markers, and 4 (19%) resulted from unrelated issues including social problems, alcohol withdrawal, or allergic reactions. Fourteen patients required readmission within 30 days; 7 cases (50%) were attributed to delayed procedural complications, and the remaining 7 cases were due to unrelated conditions such as pneumonia, urinary retention, skin rash, or suspected venous thromboembolism.

We next examined factors associated with complicated ESD (table 1). Anticoagulant use was more common in this group (37.5% vs 5.7%, p=0.001), which also had longer admissions (4 vs 1 day, p<0.001) and higher 30-day readmissions (43.8% vs 3.3%, p=0.001). As these differences were largely complication-driven, we evaluated event characteristics. Perforation occurred in 2% (5/225), with only 1% (3/225) requiring surgery. Post ESD bleeding occurred in 5% (11/225), and only 2% (5/225) required intervention. Notably, no perforations occurred in anticoagulated patients, indicating that anticoagulation primarily increases bleeding risk. Indeed, 55% (6/11) of post ESD bleeds occurred in patients on anticoagulants despite appropriate peri-procedural management in accordance with national guidelines.

Table 1. Comparison between patients with and without procedural complications 

*1 patient had both immediate and delayed complications (bleeding) 

Colorectal ESD performed with the Speedboat™ device demonstrates low complication rates, supporting safe discharge within 24 hours for most patients. Anticoagulant use was the only factor significantly associated with complications, leading to extended hospitalisation or readmission. Incorporating anticoagulation status into pre-procedural planning may therefore help identify the minority of patients who would benefit from planned post ESD admission. These findings support a selective, risk-stratified approach rather than routine overnight admission following colorectal ESD.