Wang J, Li SJ, Yan Y, Yuan P, Li WF, Cao CQ, Chen WG, Chen KN, Wu Q. Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer. World J Gastroenterol 2022; 28(41): 5957-5967 [PMID: 36405109 DOI: 10.3748/wjg.v28.i41.5957]
Corresponding Author of This Article
Qi Wu, MD, Assistant Professor, Chief Physician, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. wuqi1973@bjmu.edu.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jing Wang, Shi-Jie Li, Yan Yan, Peng Yuan, Wei-Feng Li, Chang-Qi Cao, Qi Wu, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
Shi-Jie Li, Wei-Gang Chen, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832008, Xinjiang Uygur Autonomous Region, China
Ke-Neng Chen, The First Department of Thoracic Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
Author contributions: Wang J and Li S contributed equally to this work; Wang J and Li S performed in analysis and interpretation of the data, and drafting of the manuscript; Wu Q and Chen K conceived of and designed the study; Yan Y, Yuan P, Li W, Cao C and Chen W helped to perform the analyses and critically revised the manuscript for important intellectual content; and all authors approved the final draft submitted.
Supported byWu Jie-Ping Medical Foundation Special Fund for Clinical Research, No. 320.6750.2021-04-71; Open Research Fund of NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, No. KF202101; Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences, No. 2020-PT330-003; Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, No. XMLX202143; Capital’s Funds for Health Improvement and Research, No. 2020-2-2155; and Beijing Municipal Administration of Hospitals Incubating Program, No. PX2020047.
Institutional review board statement: This study was approved by the Ethics Committee of the Peking University Cancer Hospital, No. 2022KT13.
Informed consent statement: Written informed consent was obtained from all patients or their families.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi Wu, MD, Assistant Professor, Chief Physician, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. wuqi1973@bjmu.edu.cn
Received: July 26, 2022 Peer-review started: July 26, 2022 First decision: August 31, 2022 Revised: September 15, 2022 Accepted: October 19, 2022 Article in press: October 19, 2022 Published online: November 7, 2022 Processing time: 101 Days and 0.6 Hours
ARTICLE HIGHLIGHTS
Research background
Endoscopic submucosal dissection (ESD) is an established technique for the treatment of early gastrointestinal neoplasia. Generally, a multi-day (M-D) admission is required for patients undergoing ESD due to potential complications. This retrospective study demonstrates that the same-day (S-D) discharge procedures for esophagogastric ESD may be feasible and effective.
Research motivation
ESD is safer, more cost-effective, has greater efficacy, and exhibits a positive impact on health-related quality of life in comparison with surgery. Reducing the length of hospital stay can decrease medical expenses, and some studies have attempted to shorten the duration of postprocedural hospitalization after esophageal, gastric, and colorectal ESD. However, data on the feasibility of S-D discharge after esophagogastric ESD remain limited.
Research objectives
In this study, we describe our preliminary experience with the S-D discharge strategy following ESD of the esophagus or stomach compared with conventional M-D hospital admission.
Research methods
To minimize the effect of selection bias, the propensity score matching method was applied to balance the unevenly distributed patient baseline characteristics in this non-randomized trial. Subsequently, patients in the S-D and M-D groups were paired using the 1:1 nearest available score match algorithm with a match tolerance of 0.02. Further statistical analyses were conducted to compare the differences between the two groups based on the matched data.
Research results
No significant difference was found between the groups with respect to intraoperative and postprocedural major adverse events (AEs). The tumor size, complete resection rate, and procedural duration were comparable between the groups. The S-D group demonstrated a significantly shorter length of hospital stay (P < 0.001) and lower overall medical expenses (P < 0.001) compared to the M-D group.
Research conclusions
This is the first retrospective study evaluating S-D discharge procedures for esophagogastric ESD in China. The result demonstrated the S-D discharge strategy may be feasible and effective for esophagogastric ESD, and the procedural-related AEs can be managed successfully.
Research perspectives
This first retrospective study evaluating S-D discharge procedures for esophagogastric ESD in China demonstrates that this strategy may be feasible and effective, and that the AEs related to ESD could be managed successfully. Additional prospective studies are warranted to establish more detailed standards to select patients for S-D discharge ESD.
