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Influence of hospital volume on bleeding after endoscopic submucosal dissection for early gastric cancer in Japan: a multicenter propensity score-matched analysis

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Abstract

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.

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Acknowledgements

We thank all collaborators in the Fight-Japan study group for the enrollment of patients and data collection: Sho Shiroma (Cancer Institute Hospital, Japanese Foundation for Cancer Research); Hiroyuki Odagiri (Toranomon Hospital); Kazuhiro Matsunaga and Shigenori Wakita (Ishikawa Prefectural Central Hospital); Masaki Ominami and Taishi Sakai (Osaka City University Graduate School of Medicine); Yuko Miura (The University of Tokyo); Minami Hashimoto, Jun Nakamura, and Ko Watanabe (Fukushima Medical University Hospital); Ryusuke Ariyoshi (Kobe University Graduate School of Medicine); Yutaka Okagawa, Takeyoshi Minagawa, and Ryoji Fujii (Tonan Hospital); Takao Maekita and Kazuhiro Fukatsu (Wakayama Medical University); Yoichi Hiasa (Ehime University Graduate School of Medicine); Daisuke Chinda, Hidezumi Kikuchi, and Tetsuya Tatsuta (Hirosaki University Hospital); Atsushi Goto (Yamaguchi University Graduate School of Medicine); Daisuke Maruoka, Kenichiro Okimoto, and Naoki Akizue (Chiba University Graduate School of Medicine); Tomoaki Yamasaki, Takehisa Suekane, and Yu Yasui (Osaka City General Hospital); Tsutomu Nishida and Masashi Yamamoto (Toyonaka Municipal Hospital); Keiichi Hashiguchi and Naoyuki Yamaguchi (Nagasaki University Hospital); Yoichi Akazawa and Hiroyuki Komori (Juntendo University School of Medicine); Yoshiki Tsujii, Hideki Iijima, and Tetsuo Takehara (Osaka University Graduate School of Medicine); Takashi Ohta (Kansai Rosai Hospital); Hidehiko Takabayashi (Saitama Medical Centre), Yoshiyuki Itakura (Kohnodai Hospital, National Centre for Global Health and Medicine); Kazuya Kitamura (Kanazawa University Hospital); Daisuke Akutsu (University of Tsukuba); and Toshio Uraoka (Gunma University Graduate School of Medicine). Moreover, we would like to thank Hajime Yamakage (Satista Co., Ltd.) who assisted with the statistical analyses.

Funding

The authors received no specific funding for this work.

Author information

Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan

    Yohei Yabuuchi, Naomi Kakushima & Hiroyuki Ono

  2. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Waku Hatta & Atsushi Masamune

  3. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Yosuke Tsuji

  4. Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Toshiyuki Yoshio

  5. Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Naomi Kakushima & Mitsuhiro Fujishiro

  6. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

    Shu Hoteya

  7. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

    Hisashi Doyama

  8. Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan

    Yasuaki Nagami

  9. Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan

    Takuto Hikichi

  10. Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan

    Masakuni Kobayashi

  11. Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Kobe, Japan

    Yoshinori Morita

  12. Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshinori Morita

  13. Department of Gastroenterology, Tonan Hospital, Sapporo, Japan

    Tetsuya Sumiyoshi

  14. Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

    Mikitaka Iguchi

  15. Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan

    Hideomi Tomida

  16. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan

    Hideomi Tomida

  17. Division of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan

    Takuya Inoue

  18. Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan

    Tatsuya Mikami

  19. Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan

    Kenkei Hasatani

  20. Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan

    Jun Nishikawa

  21. Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Japan

    Tomoaki Matsumura

  22. Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan

    Hiroko Nebiki

  23. Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan

    Dai Nakamatsu

  24. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan

    Ken Ohnita

  25. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Haruhisa Suzuki

  26. Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan

    Hiroya Ueyama

  27. Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoshito Hayashi

  28. Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Shiga, Japan

    Mitsushige Sugimoto

  29. Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan

    Mitsushige Sugimoto

  30. Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Amagasaki, Japan

    Shinjiro Yamaguchi

  31. Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama, Japan

    Tomoki Michida

  32. Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

    Tomoki Michida

  33. Division of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan

    Tomoyuki Yada

  34. Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan

    Yoshiro Asahina

  35. Division of Endoscopic Center, University of Tsukuba Hospital, Tsukuba, Japan

    Toshiaki Narasaka

  36. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan

    Shiko Kuribayashi

  37. Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan

    Shu Kiyotoki

  38. Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan

    Katsuhiro Mabe

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  1. Yohei Yabuuchi
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Corresponding author

Correspondence to Yohei Yabuuchi.

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Disclosures

Yosuke Tsuji declared that he received personal fees from Olympus, Daiichi Sankyo, AstraZeneca, and Takeda Pharmaceutical and research grants from HOYA Pentax, Gunze, and Nipro outside the submitted work. Toshiyuki Yoshio declared that he received research grants from Takeda Science Foundation and JSPS KAKENHI Grant (number 19K08408) outside the submitted work. Hisashi Doyama declared that he received personal fees from Otsuka Pharmaceutical, Otsuka Pharmaceutical Factory, Eisai, EA Pharma, AstraZeneca, and Olympus outside the submitted work. Mitsuhiro Fujishiro declared that he received personal fees from Takeda Pharmaceutical, EA Pharma, and Nihon Pharmaceutical and that his department received research grants from HOYA Pentax, EA Pharma, Eisai, Taiho Pharmaceutical, AbbVie GK, Nippon Kayaku, Chugai Pharmaceutical, Gilead Sciences, Kyorin Pharmaceutical, and Mitsubishi Tanabe Pharma outside the submitted work. Atsushi Masamune declared that he received personal fees from EA Pharma, Takeda Pharmaceutical, Daiichi Sankyo Co., and Lylan.co.jp, and commercial research funding from Otsuka Pharmaceutical, EA Pharma, Gilead Sciences, Asahi Kasei Pharma, Eisai, AbbVie GK, Takeda Pharmaceutical, and Daiichi Sankyo outside the submitted work. Hiroyuki Ono declared that he received personal fees from Otsuka Pharmaceutical, EA Pharma, Boston Scientific, AstraZeneca, and Olympus outside the submitted work. Yohei Yabuuchi, Waku Hatta, Naomi Kakushima, Shu Hoteya, Yasuaki Nagami, Takuto Hikichi, Masakuni Kobayashi, Yoshinori Morita, Tetsuya Sumiyoshi, Mikitaka Iguchi, Hideomi Tomida, Takuya Inoue, Tatsuya Mikami, Kenkei Hasatani, Jun Nishikawa, Tomoaki Matsumura, Hiroko Nebiki, Dai Nakamatsu, Ken Ohnita, Haruhisa Suzuki, Hiroya Ueyama, Yoshito Hayashi, Mitsushige Sugimoto, Shinjiro Yamaguchi, Tomoki Michida, Tomoyuki Yada, Yoshiro Asahina, Toshiaki Narasaka, Shiko Kuribayashi, Shu Kiyotoki, and Katsuhiro Mabe have no conflicts of interest or financial ties to disclose.

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Yabuuchi, Y., Hatta, W., Tsuji, Y. et al. Influence of hospital volume on bleeding after endoscopic submucosal dissection for early gastric cancer in Japan: a multicenter propensity score-matched analysis. Surg Endosc 36, 4004–4013 (2022). https://doi.org/10.1007/s00464-021-08721-6

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  • DOI: https://doi.org/10.1007/s00464-021-08721-6

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