Hospital volume and adverse events following esophageal endoscopic submucosal dissection in Japan

Abstract

Background and study aims Esophageal endoscopic submucosal dissection (ESD) has gradually acquired popularity as a minimally invasive surgery for early cancers not only in Japan, but also in other countries. However, most reported outcomes have been based on relatively small samples of patients from specialized centers. Therefore, the association between hospital volume and the rate of adverse events following esophageal ESD has been poorly understood.

Patients and methods Using a nationwide administrative database in Japan, we identified patients who underwent esophageal ESD between 1 July 2007 and 31 March 2013. Hospital volume was defined as the number of esophageal ESD procedures performed per year at each hospital and was categorized into quartiles.

Results In total, 12 899 esophageal ESD procedures at 699 institutions were identified during the study period. Perforation and perforation-related disorders were observed in 422 patients (3.3 %), and one patient died after perforation. There was a significant association between a lower hospital volume and a higher proportion of adverse events following esophageal ESD. Although not statistically significant, a similar tendency was observed in the occurrence of blood transfusion within 1 week after ESD and all-cause in-hospital death. Multivariable logistic regression analysis showed that hospitals with very high case volumes were less likely to experience adverse events following esophageal ESD than hospitals with very low volumes.

Conclusions The proportion of perforation and perforation-related disorders following esophageal ESD was permissibly low, and there was a linear association between higher hospital volume and lower rates of adverse events following esophageal ESD.

• References

• 1 Hammad H, Kaltenbach T, Soetikno R. Endoscopic submucosal dissection for malignant esophageal lesions. Curr Gastroenterol Rep 2014; 16: 386
• 2 Rong QH, Zhao GL, Xie JP. et al. Feasibility and safety of endoscopic submucosal dissection of esophageal or gastric carcinomas under general anesthesia. Med Princ Pract 2013; 22: 280-284
• 3 Chaves DM, Moura EGH, Milhomem D. et al. Initial experience of endoscopic submucosal dissection in Brazil to treat early gastric and esophageal cancer: a multi-institutional analysis. Arq Gastroenterol 2013; 50: 148-152
• 4 Repici A, Hassan C, Carlino A. et al. Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc 2010; 71: 715-721
• 5 Ishihara R, Iishi H, Takeuchi Y. et al. Local recurrence of large squamous-cell carcinoma of the esophagus after endoscopic resection. Gastrointest Endosc 2008; 67: 799-804
• 6 Toyonaga T, Man-i M, East JE. et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
• 7 Ono S, Fujishiro M, Niimi K. et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 2009; 70: 860-866
• 8 Yamashina T, Ishihara R, Nagai K. et al. Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma. Am J Gastroenterol 2013; 108: 544-551
• 9 Wang J, Ge J, Zhang X-H. et al. Endoscopic submucosal dissection versus endoscopic mucosal resection for the treatment of early esophageal carcinoma: a meta-analysis. Asian Pac J Cancer Prev 2014; 15: 1803-1806
• 10 Takahashi H, Arimura Y, Masao H. et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 2010; 72: 255-264
• 11 Higuchi K, Tanabe S, Azuma M. et al. A phase II study of endoscopic submucosal dissection for superficial esophageal neoplasms (KDOG 0901). Gastrointest Endosc 2013; 78: 704-710
• 12 Odagiri H, Yasunaga H, Matsui H. et al. Hospital volume and the occurrence of bleeding and perforation following colorectal endoscopic submucosal dissection: analysis of a national administrative database in Japan. Dis Colon Rectum 2015; 58: 597-603
• 13 Murata A, Okamoto K, Muramatsu K. et al. Endoscopic submucosal dissection for gastric cancer: the influence of hospital volume on complications and length of stay. Surg Endosc 2014; 28: 1298-1306
• 14 Matsuda S, Ishikawa KB, Kuwabara K. et al. Development and use of the Japanese case-mix system. Eurohealth 2008; 14: 25-30
• 15 Kim JS, Kim BW, Shin IS. Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia: a meta-analysis. Dig Dis Sci 2014; 59: 1862-1869
• 16 Hirasawa K, Kokawa A, Oka H. et al. Superficial adenocarcinoma of the esophagogastric junction: long-term results of endoscopic submucosal dissection. Gastrointest Endosc 2010; 72: 960-966
• 17 Yamada M, Oda I, Nonaka S. et al. Long-term outcome of endoscopic resection of superficial adenocarcinoma of the esophagogastric junction. Endoscopy 2013; 45: 992-996
• 18 Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med 2003; 349: 2241-2252
• 19 Tachimori Y, Ozawa S, Fujishiro M. et al. Comprehensive registry of esophageal cancer in Japan, 2005. Esophagus 2014; 11: 1-20
• 20 Tachimori Y, Ozawa S, Fujishiro M. et al. Comprehensive registry of esophageal cancer in Japan, 2006. Esophagus 2014; 11: 21-47
• 21 Tsuji Y, Nishida T, Nishiyama O. et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy 2015; 47: 775-783
• 22 Saito Y, Uraoka T, Yamaguchi Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225