Background

Information on whether there is a relationship between hospital volume and bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is limited. This study aimed to compare the bleeding rates after ESD for EGC according to the hospital volume.

Methods

Patients who underwent ESD for EGC at 33 institutions in Japan between November 2013 and October 2016 were included in this multicenter retrospective study. Hospital volume was categorized into three groups, based on the average annual number of ESD procedures: low- and medium-volume group (LMVG), high-volume group (HVG), and very high-volume group (VHVG). The bleeding rate after ESD for EGC was compared between the three hospital volume groups after propensity score matching.

Results

A total of 10,320 patients, including 2797 patients in the LMVG, 4646 patients in the HVG, and 2877 patients in the VHVG, were identified. Propensity score matching yielded 2002 patients in each hospital volume group, with an improved balance of confounding variables between the three groups. The bleeding rates in the LMVG, HVG, and VHVG were 4.3%, 3.7%, and 4.9%, respectively, and no significant difference was noted between the three groups.

Conclusions

The bleeding rate after ESD for EGC did not differ between hospitals in Japan. The finding indicated that ESD for EGC is equally feasible across Japanese hospitals of different volumes regarding bleeding after ESD.

中文翻译：

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日本早期胃癌内镜粘膜下剥离术后出血量对医院容量的影响：多中心倾向评分匹配分析

背景

关于早期胃癌 (EGC) 的内镜粘膜下剥离术 (ESD) 后住院量与出血之间是否存在关系的信息有限。本研究旨在根据医院容量比较 ESD 治疗 EGC 后的出血率。

方法

本项多中心回顾性研究纳入了 2013 年 11 月至 2016 年 10 月期间在日本 33 家机构接受 ESD 治疗 EGC 的患者。根据 ESD 手术的年均数量，医院容量分为三组：中低容量组 (LMVG)、高容量组 (HVG) 和超高容量组 (VHVG)。在倾向评分匹配后，比较三个医院容量组之间 ESD 治疗 EGC 后的出血率。

结果

总共确定了 10,320 名患者，包括 LMVG 中的 2797 名患者、HVG 中的 4646 名患者和 VHVG 中的 2877 名患者。倾向得分匹配在每个医院容量组中产生了 2002 名患者，三组之间的混杂变量平衡得到改善。LMVG、HVG 和 VHVG 的出血率分别为 4.3%、3.7% 和 4.9%，三组之间无显着差异。

结论

EGC ESD 后的出血率在日本的医院之间没有差异。研究结果表明，针对 ESD 后出血的不同数量的日本医院，EGC 的 ESD 同样可行。