Safety of long vs. short fasting after ESD/STER for esophageal tumors ≤ 2 cm: a propensity score-matching study

Endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) have become the safe and effective techniques for early-stage esophageal cancer and small-diameter submucosal tumors of the esophagus. Yet, there remains insufficient research on the appropriate fasting period following ESD or STER in patients with early esophageal neoplasms. This study aims to assess the impact of different fasting durations-long versus short-on postoperative complication rates and hospital stay durations.

Patients with esophageal tumors less than 2 cm in diameter who underwent ESD or STER between 2014 and 2020 in the Department of Gastroenterology at the First Affiliated Hospital of Nanchang University were analyzed.

In intention to treat (ITT) analysis, 266 patients were part of the long fasting group, and 93 patients were part of the short fasting group. After matching, propensity score matching analysis (PSMA) resulted in 88 matched pairs between short and long fasting group, covariates were well balanced across both groups. Stratified analysis of esophageal ESD or STER indicate that the incidence of Postoperative discomfort and complications did not differ significantly between the two groups(all P > 0.05). And the length of hospital stay remained significantly longer in the long fasting group compared to the short fasting group with esophageal ESD (7.63 ± 2.56 days vs. 6.52 ± 2.17 days, P = 0.01) or esophageal STER (7.86 ± 2.07 days vs. 6.67 ± 1.90 days, P = 0.037). Supplementary per protocol (PP) analysis also showed similar trends in the incidence of Postoperative adverse events or complications and the hospitalization duration.

For small esophageal tumors (< 2 cm), short fasting after ESD or STER shows similar complication rates to long fasting but significantly shortens hospitalization, Improving its efficiency in postoperative care.