Low rate of general anaesthesia and hospital admission following colonic saline-immersion/irrigation technique (SITE) endoscopic submucosal dissection (ESD)

Introduction: Endoscopic submucosal dissection (ESD) for colonic lesions frequently requires general anaesthesia (GA) or deep sedation to be performed. Saline-immersion/irrigation technique (SITE) improves tolerability as it reduces bowel distension and less stretching of the mesentery. We describe our experience with operator-delivered sedation (OdS) SITE-ESD on a cohort of colonic ESD. Materials and Methods: Retrospective single-centre study of consecutive anonymised patients who underwent SITE-ESD for colonic lesions from Nov-2017 to Feb-2025. Characteristics of patients and lesions, procedure outcomes and adverse events, details of sedation, and hospital admission were recorded. Results: One-hundred-thirty-eight colonic lesions were included. Median age: 68 (IQR 62-76), ASA II was the most prevalent score (61.1%), the median maximum diameter of lesions was 40 mm (IQR 30-50), and the median resection time was 120 min (IQR 75-180). One-hundred-twenty-seven (127, 92.0%) procedures were performed under OdS with midazolam (median 6 mg; IQR 3.5-7.5) and fentanyl (137.5 mcg; IQR 100-200). No procedure was abandoned due to discomfort. Eighty-one (58.7%) procedures were day cases and of the remaining 57, 46 (80.7%) required less than 48 hrs admission. One case of moderate respiratory failure was recorded (AGREE II). Discussion: SITE with OdS can be considered for colonic ESD.