Timing of Oral Intake After Colorectal Endoscopic Submucosal Dissection: A Propensity Score-Matched Study

The optimal timing for resuming oral intake after colorectal endoscopic submucosal dissection (ESD) remains unclear. This study evaluated the safety and feasibility of initiating oral intake on postoperative day (POD) 1 compared with POD 2.

We retrospectively reviewed 220 patients who underwent colorectal ESD between 2017 and 2024 at Kyoto Katsura Hospital. Patients with incomplete procedures or delayed intake due to complications were excluded. According to the institutional pathway, oral intake was resumed on POD 1 (Early group) or POD 2 (Late group). After 1:1 propensity score matching using eight baseline covariates, 58 patients were included in each group. The primary outcome was procedure-related adverse events within 30 days. Secondary outcomes included postoperative symptoms and short-term body weight change.

After matching, baseline characteristics were well balanced. Adverse event rates were comparable: postoperative bleeding (5% Early vs. 2% Late) and delayed perforation (0% vs. 2%), all managed conservatively. No significant differences were observed in postoperative fever (9% vs. 10%) or abdominal pain (10% vs. 7%). Weight loss on POD 3 was significantly smaller in the Early group (97.8% vs. 96.0% of baseline, P < 0.05).

Early oral intake after colorectal ESD was not associated with an increased risk of adverse events, suggesting that early feeding is a reasonable option for selected patients. Nevertheless, because these findings are exploratory, larger prospective studies are needed to establish whether early feeding can be adopted routinely.