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.
