Propensity score-matching analysis to compare clinical outcomes of endoscopic submucosal dissection for early gastric cancer in the postoperative and non-operative stomachs

Abstract

BackgroundEndoscopic submucosal dissection (ESD) of the postoperative stomach (ESD-P) for early gastric cancer (EGC) is considered a technically difficult procedure. However, it is difficult to compare the outcomes of ESD-P and ESD of the non-operative stomach (ESD-N) because their baseline characteristics are different. Therefore, we aimed to compare the technical outcomes of ESD-P with those of ESD-N using a propensity score-matching analysis to compensate for the differences.MethodsThe chart records of 1046 patients with EGC who were treated with ESD between January 2004 and July 2016 at Kitakyushu Municipal Medical Center in Japan were reviewed in this retrospective study. Multivariate analyses and propensity score-matching were performed for age, sex, lesion location, lesion size, tumor invasion, tumor size, ulcer (scar), and operator skill. The primary outcome was procedure time. Secondary outcomes were percentages of en bloc, complete, and curative resections, and percentages of adverse events, which were evaluated between the two groups.ResultsForty-one patients were in the ESD-P group and 1005 patients were in the ESD-N group. Propensity score-matching created 41 matched pairs. According to the adjusted comparisons, ESD-P required a significantly longer procedure time (85 min vs 51 min, p < 0.001). Other treatment outcomes showed an en bloc resection rate of 100% for both groups (p = 1) and complete resection rates of 95.1 and 97.6% (p = 1), curative resection rates of 90.2 and 90.2% (p = 1), perforation during ESD rates of 2.4 and 0% (p = 1), and postprocedure bleeding rates of 2.4 and 2.4% (p = 1) for the ESD-P and ESD-N groups, respectively. For the ESD-P group, lesions on the suture line or anastomotic site were significantly associated with longer procedure times (p = 0.038).ConclusionsESD-P was a more time-consuming procedure than ESD-N. However, ESD-P and ESD-N achieved high rates of curative resection with a low rate of adverse events for the treatment of EGC. ESD could be selected as the treatment for EGC even in the postoperative stomach provided that careful attention is given to lesions on the suture line or anastomotic site.

Efficacy and timing of gastrografin administration after ileus tube insertion in patients with adhesive small bowel obstruction

“…There were confounding biases between the two study groups, as this was a nonrandomized study. Thus, propensity-score matching analysis, which has been used to compensate for confounding factors, was adopted in this study [10][11][12].…”

“…3 [2][3][4] vs. 3 [2][3] days, P = 0.51; median period of hospital admission: 12.5 [9.25-14] vs. 11 [9][10][11][12][13][14][15] days, P = 0.14). However, the median period of ileus tube intubation was significantly shorter in the NEGA group than in the EGA group (7 [5-8] vs. 5 [4][5][6][7] days, P = 0.007).…”

“…Period of hospital admission, median (days) [IQR] 11 [9][10][11][12][13][14] 12.5 [9.25-14] Adverse event, n (%) 1 (0.7) 1 (1.5) EGA, early gastrografin administration; NEGA, non-early gastrografin administration; IQR, interquartile range P-value was calculated using Fisher's exact test for categorical data. P-value was calculated using the Mann-Whitney U test for continuous data distributed abnormally.…”

Early gastrografin administration after ileus tube insertion does not improve the clinical outcomes in patients with adhesive small bowel obstruction

“…Thus, propensity-score matching analysis, which has been used to compensate for confounding factors, was adopted in this study [9][10][11]. Logistic regression of factors, including background characteristics, and propensity score were calculated.…”

“…In the NEGA group, 5.9% (5/85) of patients were successfully treated without gastrografin administration. The median period until the first stool and median period of hospital admission were not significantly different between the EGA and NEGA groups (median period until the first stool: 3 [IQR, 2-4] vs. 3 [IQR, 2-3] days, P = 0.51; median period of hospital admission: 12.5 [IQR, 9.25-14] vs. 11 [IQR, [9][10][11][12][13][14][15] days, P = 0.14). However, the median period of ileus tube intubation was significantly shorter in the NEGA group than in the EGA group (7 [IQR, [5][6][7][8] vs. 5 [IQR, 4-7] days, P = 0.007).…”