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THE INFLUENCE OF PROCEDURAL VOLUME ON THE OUTCOME OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTRIC NEOPLASM: A NATIONWIDE POPULATION-BASED STUDY USING ADMINISTRATIVE DATA

Jae Yong Park 1, Mi-Sook Kim 2, Beom Jin Kim 1, Jae Gyu Kim 1

Affiliations

1 Chung-Ang University College of Medicine, Seoul, Korea, Republic of

2 Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, Korea, Republic of

Summary

AI Generated

Higher hospital procedural volume for gastric endoscopic submucosal dissection is associated with lower rates of bleeding, perforation, and pneumonia in a Korean nationwide database study of 89,780 patients.

Very high-, high-, and low-volume hospitals showed significantly lower composite adverse event rates compared to very low-volume hospitals, with odds ratios of 0.627, 0.542, and 0.697 respectively.
Among 95,411 gastric ESD procedures for cancer or adenoma between 2011 and 2017, there were 5,098 bleeding events, 601 perforations, and 712 pneumonia cases.
The volume-outcome relationship was evident for bleeding, perforation, and pneumonia but not for additional resection within 180 days.
The authors recommend systematic nationwide monitoring of gastric ESD outcomes to ensure procedural quality and patient safety.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

For gastric neoplasms, endoscopic submucosal dissection (ESD) is a well-known therapeutic option. Our study aimed to investigate the influence of procedural volume on the outcome of gastric ESD.

Aims & Methods

Patients who received ESD for gastric cancer or adenoma from November 2011 to December 2017 were identified using the Korean National Health Insurance Service database. The diagnostic and procedure codes were combined to develop operational definitions, which were validated using individual hospital medical record data. Outcomes included bleeding, perforation, pneumonia, 30-day mortality, composite outcome comprising all these adverse outcomes, and additional resection. Hospital volume was categorized into four groups: very high-, high-, low-, very low-volume hospitals (VHVH, HVH, LVH, VLVH). The outcomes of ESD were compared in relation to hospital volume.

Results

A total of 89,780 patients underwent 95,411 procedures during the research period. There were 5,607 composite events, which included 5,098 bleeding, 601 perforation, and 712 pneumonia cases, respectively. Additional resection occurred within 180days in 7,900 cases. There were significant differences in ESD-related adverse outcomes among the four hospital volume categories. Multiple logistic regression revealed that VHVH, HVH, and LVH were associated with lower risk of a composite outcome, when compared to VLVH (OR, 0.627, 95% CI, 0.445-0.885, p=0.008; OR, 0.542, 95% CI, 0.406-0.722, p<0.001; OR, 0.697, 95% CI, 0.548-0.886, p=0.003). Similar tendencies were also shown for bleeding, perforation, and pneumonia, although this was not evident in additional resection.

Conclusion

The procedural volume at an institutional level was closely associated with clinical outcomes, such as bleeding, perforation, pneumonia, and a composite outcome, in patients with ESD for gastric cancer or adenoma. The outcomes of gastric ESD should be closely and systemically monitored in a nationwide level, to ensure the quality of procedures and the safety of patients.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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ASSOCIATION OF ORAL HEALTH AND PERIODONTAL DISEASE WITH ESOPHAGEAL CANCER RISK: A NATIONWIDE POPULATION-BASED STUDY INTEGRATING DENTAL HEALTH SCREENING AND CLAIMS-BASED DATA

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