Clinical Scorecard: Preoperative Conditioning through Prehabilitation in Patients Undergoing Endoscopic Submucosal Dissection: Results from a Randomized Controlled Study

At a Glance

Key Highlights

• Prehabilitation is a 4-week multimodal preoperative program aiming to improve postoperative recovery in ESD patients.
• The program includes individualized exercise training, nutritional optimization, and psychological support delivered by a multidisciplinary team.
• Prehabilitation has demonstrated benefits in major surgeries but its role in minimally invasive ESD was previously unstudied.

Guideline-Based Recommendations

Diagnosis

• Identify candidates for ESD based on early gastrointestinal neoplasms suitable for endoscopic resection.

Management

• Implement a 4-week prehabilitation program prior to ESD including structured exercise, nutritional support, and psychological preparation.
• Ensure individualized prehabilitation plans based on baseline physical, nutritional, and psychological assessments.
• Maintain weekly monitoring and support to optimize adherence to the prehabilitation regimen.

Monitoring & Follow-up

• Track patient adherence to exercise and nutrition plans during prehabilitation.
• Monitor for any adverse events or difficulties during the prehabilitation period.
• Assess postoperative outcomes including functional status, complication rates, length of hospital stay, and quality of life.

Risks

• Potential sedation-related side effects and bleeding risks remain in ESD despite its minimally invasive nature.
• Prehabilitation should be tailored to avoid overexertion or nutritional imbalance in frail or elderly patients.

Patient & Prescribing Data

Adults undergoing elective ESD for early gastrointestinal lesions, including older or frail individuals.

Prehabilitation is feasible and potentially beneficial in improving postoperative recovery, functional capacity, and quality of life in ESD patients.

Clinical Best Practices

• Use a multidisciplinary team to deliver prehabilitation including rehabilitation specialists, dietitians, psychologists, and surgeons.
• Individualize prehabilitation programs based on comprehensive baseline assessments.
• Provide continuous support and monitoring to enhance patient adherence and safety.
• Incorporate prehabilitation as a standard preoperative care component for ESD candidates to optimize outcomes.

References

• Systematic reviews and meta-analyses on prehabilitation in major elective surgeries
• Network meta-analysis on combined prehabilitation improving postoperative functional capacity and quality of life
• Multicenter trial demonstrating reduced complications with prehabilitation in colorectal surgery
• Systematic review of economic evaluations showing cost-effectiveness of prehabilitation
• CONSORT 2025 guidelines for randomized trials
• Chinese Clinical Trial Registry ChiCTR2500103062