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Optimal procedure-related hospitalization using clinical pathway protocols following gastric endoscopic submucosal dissection

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Abstract

Background

The clinical pathway (CP) protocols simplified a systematic process from hospitalization to discharge, and were conducted to achieve standardization of the treatment process as well as improve outcomes. Thus, we investigated the optimal procedure-related hospitalization period following gastric endoscopic submucosal dissection (ESD) by comparing the rate of delayed bleeding (DB) and perforation according to CP protocols.

Methods

We retrospectively enrolled 630 patients who underwent ESD for gastric dysplasia or early gastric cancer (EGC); Group A (368 patients) followed Protocol A for a hospital stay of a single night; Group B (262 patients) followed Protocol B for a hospital stay of two nights.

Results

The patient characteristics were comparable between the two groups, except for pathologic diagnosis (42.1% in Group A vs. 32.1% in Group B for EGC). DB occurred in 21 patients, and there was no significant difference in the overall DB rates between Group A (12/368 = 3.3%) and Group B (9/262 = 3.4%) (P = 0.904). The DB rates were 2.5% (8/315) and 7.5% (4/53) in Group A, and 2.7% (6/223) and 7.7% (3/39) in Group B, without and with the use of antiplatelets, respectively, and 33.3% (1/3) in Group A and 50.0% (1/2) in Group B with the use of dual antiplatelets. DB developed at various intervals post-discharge from 2 to 17 days, and was successfully controlled by endoscopic hemostasis in most cases. There were no deaths or surgeries required as a result of uncontrolled DB and no postoperative delayed perforation occurred.

Conclusions

The CP protocols with a one-night hospitalization following gastric ESD decreased the hospital stay and did not influence postoperative complications compared to those with two-night hospitalizations.

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Abbreviations

CIs:

Confidence intervals

CP:

Clinical pathway

DB:

Delayed bleeding

EGC:

Early gastric cancer

ESD:

Endoscopic submucosal dissection

IT:

Insulation-tipped

ORs:

Odds ratios

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Acknowledgements

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Authors and Affiliations

  1. Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, 361-763, Korea

    Daehyun Kim, Hyoung Woo Kim, Ki Bae Kim, Joung-Ho Han, Soon Man Yoon, Hee Bok Chae, Seon Mee Park & Sei Jin Youn

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Contributions

Study design, HWK; Investigation, DK, HWK, KBK and JH; Analysis and interpretation, HWK., SMY. and HBC; Writing of manuscript, DK and HWK; Review & Editing; SMP and SJY; Supervision, HWK and HBC.

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Correspondence to Hyoung Woo Kim.

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Drs. Daehyun Kim, Hyoung Woo Kim, Ki Bae Kim, Joung-Ho Han, Soon Man Yoon, Hee Bok Chae, Seon Mee Park, and Sei Jin Youn have no conflicts of interest or financial ties to disclose.

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Kim, D., Kim, H.W., Kim, K.B. et al. Optimal procedure-related hospitalization using clinical pathway protocols following gastric endoscopic submucosal dissection. Surg Endosc 35, 2846–2854 (2021). https://doi.org/10.1007/s00464-020-07720-3

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