Post written by Nik Dekkers, MD, from Leiden University Medical Center, Leiden, The Netherlands.

The focus of our study was to quantitatively assess physical recovery after endoscopic submucosal dissection (ESD) and transanal minimally invasive surgery (TAMIS) for large rectal lesions. We used wearable accelerometers (smartwatches) to objectively measure physical activity and to investigate key factors influencing recovery.

We considered this study important because, despite the widespread use of ESD and TAMIS as standard-of-care resection techniques, quantitative data on patients’ recovery are lacking. Functional recovery and patient-reported outcomes are increasingly relevant in value-based health care, but patients report unmet information needs regarding their recovery trajectory, as shown in a previous study by our group.¹ By objectively measuring physical activity with smartwatches, we aimed to provide reliable data to guide patient counseling, identify those at risk for delayed recovery, and explore potentially modifiable factors influencing recovery.

To the best of our knowledge, our study is the first to quantitatively assess physical recovery after ESD and TAMIS using wearable accelerometers. Within a 28-day follow-up window, we demonstrated that ESD was noninferior to TAMIS in terms of mean recovery time, with patients recovering on average in 13.9 versus 21.0 days, respectively. ESD patients also showed faster early recovery and reported less postprocedural pain. Recovery trajectories correlated closely with self-reported recovery, supporting the validity of smartwatch-based monitoring.

These findings add to existing knowledge by providing objective data on physical recovery after local en bloc resection techniques, addressing previously reported unmet information needs among patients. Moreover, we identified postprocedural pain, larger polyp size, and proximity to the dentate line as factors associated with delayed recovery, highlighting targets for improved perioperative management. High compliance with smartwatch monitoring demonstrates the feasibility of this approach in clinical practice.

Next steps include validating these potential risk factors in larger populations, assessing recovery beyond 28 days, and examining how wearable monitoring can support early identification of patients at risk for adverse events, enabling more personalized postprocedural care.

Graphical abstract

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

1. Dekkers N, Dang H, de Graaf M, et al. T1 colorectal cancer patients’ perspective on information provision and therapeutic decision-making after local resection. United European Gastroenterol J 2024;12:1367-77. ↩︎