A comparison of outcomes of endoscopic submucosal dissection (ESD) For early gastric neoplasms between high-volume and low-volume centers: multi-center retrospective questionnaire study conducted by the Nagano ESD Study Group.
OBJECTIVE
Outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasms at low-volume centers have been unknown, because all previous reports have studied in advanced single centers. The aim of this study was to compare ESD outcomes between high- and low-volume centers.


METHODS
A retrospective questionnaire survey was conducted and 30 centers (96.8%) responded. The complete en-bloc resection rate (CERR) and the incidence of complications were analyzed. Early gastric cancer (EGC) was divided into three categories on the basis of pathological diagnosis-standard indication (SI), expanded indication (EI) and out-of-indication (OI).


RESULTS
A total of 703 early gastric neoplasms (586 EGCs, 117 gastric adenomas) were treated with ESD from January to December 2005. The institutions that treated more than 30 cases a year were classified as high-volume centers, and those with less than 30 cases, low-volume centers. In SI, the CERRs at high- and low-volume centers were 92.1% and 91.1%, in EI, CERRs were 86.2% and 82.6% and in OI, CERRs were 80.3% and 88.0%. The perforation rates at high- and low-volume centers were 3.6% and 4.7%. The intra-operative bleeding rates at high- and low-volume centers were 0.26% and 0%, while the delayed bleeding rates were 0% and 0.63%.


CONCLUSIONS
There were no significant difference in the outcomes of ESD for early gastric neoplasms between high- and low volume centers.
Department of Gastroenterology, Saku Central Hospital, Nagano. kinichi1@janis.or.jp
Kinichi
K
Hotta
Tsuneo
T
Oyama
Taiji
T
Akamatsu
Akihisa
A
Tomori
Osamu
O
Hasebe
Naoshi
N
Nakamura
Eigo
E
Kojima
Tomoaki
T
Suga
Hideharu
H
Miyabayashi
Hiroshi
H
Ohta
D000230:Adenocarcinoma / Q000601:surgery; D000236:Adenoma / Q000601:surgery; D004210:Dissection; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D007564:Japan; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome