Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

Table 1 Comparison of clinicopathological features of the same-day discharge and multi-day discharge groups

Characteristics	Overall sample, n = 470		SMD value	P value	Matched sample, n = 156		SMD value	P value
	S-D, n = 91	M-D, n = 379			S-D, n = 78	M-D, n = 78
Age in yr			-0.052	0.657			0.025	0.402
≤ 60	33 (36.3)	147 (38.8)			30 (38.5)	25 (32.1)
> 60	58 (63.7)	232 (61.2)			48 (61.5)	53 (67.9)
Sex			0.069	0.550			-0.057	1.000
Female	21 (23.1)	99 (26.1)			16 (20.5)	16 (20.5)
Male	70 (76.9)	280 (73.9)			62 (79.5)	62 (79.5)
ASA physical status			0.224	0.039			0.000	1.000
≤ 2	89 (97.8)	347 (91.6)			76 (97.4)	75 (96.2)
≥ 2	2 (2.2)	32 (8.4)			2 (2.6)	3 (3.8)
Comorbidities			-0.087	0.457			-0.050	0.423
No	45 (49.5)	171 (45.1)			37 (47.4)	42 (53.8)
Yes	46 (50.5)	208 (54.9)			41 (52.6)	36 (46.2)
Antithrombotic agents use			-0.164	0.141			-0.041	1.000
Yes	5 (5.5)	40 (10.6)			4 (5.1)	5 (6.4)
No	86 (94.5)	339 (89.4)			74 (94.9)	73 (93.6)
Location of lesion			-0.197	0.168			0.176	0.357
Esophagus	23 (25.3)	115 (30.3)			22 (28.2)	27 (34.6)
Upper 1/3 of the stomach	18 (19.8)	97 (25.6)			14 (17.9)	20 (25.6)
Middle 1/3 of the stomach	22 (24.2)	89 (23.5)			20 (25.6)	15 (19.2)
Lower 1/3 of the stomach	28 (30.7)	78 (20.6)			22 (28.3)	16 (20.6)
Macroscopic appearance, type			0.184	0.092			0.000	1.000
0-II	89 (97.8)	383 (93.1)			76 (97.4)	75 (96.2)
0-I and 0-III	2 (2.2)	26 (6.9)			2 (2.6)	3 (3.8)
Tumor differentiation			0.316	0.004			-0.064	0.442
Differentiated	85 (93.4)	307 (81.0)			73 (93.6)	76 (97.4)
Undifferentiated	6 (6.6)	72 (19.0)			5 (6.4)	2 (2.6)
Depth of invasion			0.258	0.022			0.030	1.000
Intramucosal	81 (89.0)	297 (78.4)			69 (88.5)	69 (88.5)
Submucosal	10 (11.0)	82 (21.6)			9 (11.5)	9 (11.5)
Specimen size in mm, mean ± SD	31.2 ± 12.3	43.9 ± 17.0	0.749	0.000	33.3 ± 11.9	33.6 ± 15.5	0.031	0.913

ASA: American Society of Anesthesiologists; M-D: Multi-day; S-D: Same-day; SD: Standard deviation; SMD: Standardized mean difference.

Table 2 Pathological characteristics of the specimen in the same-day discharge and multi-day discharge groups

Characteristics	Matched sample, n = 156		P value
	S-D, n = 78	M-D, n = 78
Tumor size in mm	17.8 ± 11.6	17.3 ± 10.4	0.778
En bloc resection	77 (98.7)	76 (94.7)	1.000
Free horizontal margin	78 (100.0)	77 (98.7)	1.000
Free vertical margin	76 (97.4)	76 (97.4)	1.000
Complete resection	75 (96.2)	73 (93.6)	0.719

Table 3 Comparison of procedural time, hospitalization, and cost in the same-day discharge and multi-day discharge groups

Characteristics	Matched sample, n = 156		P value
	S-D, n = 78	M-D, n = 78
Procedure time in min	60.5 ± 34.9	65.8 ± 43.0	0.397
Hospitalization in d
Total	1	4.6 ± 2.0	0.000
Postprocedural	0	3.0 ± 1.8	0.000
Medical expenses in CNY	25749.0 ± 4389.3	37000.8 ± 8510.7	0.000
Procedure: ESD, anesthesia, other procedures	3616.1 ± 942.8	6079.3 ± 1646.5	0.000
Medical devices	13112.0 ± 1884.5	17956.7 ± 4977.2	0.000
Medication	6390.7 ± 3866.4	7759.9 ± 2241.8	0.008
Diagnostic test: Endoscopy, laboratory, radiology, pathology	3625.5 ± 1133.9	4025.9 ± 1561.5	0.069
Administration: Hospitalization, nursing	260.0 ± 232.7	1178.9 ± 1506.7	0.000

CNY: Chinese Yuan; ESD: Endoscopic submucosal dissection.

Table 4 Major adverse events of same-day discharge and multi-day discharge groups

Characteristics	Overall sample, n = 470		P value	Matched sample, n = 156		P value
	S-D, n = 91	M-D, n = 379		S-D, n = 78	M-D, n = 78
Total major adverse events	3 (3.3)	32 (8.4)	0.093	3 (3.8)	6 (7.7)	0.495
Intraprocedural perforation	0	14 (3.7)	0.083	0	3 (3.8)	0.245
Postprocedural bleeding during SSLE	3 (3.3)	18 (4.7)	0.778	3 (3.8)	3 (3.8)	1.000
Oozing bleeding	2 (2.2)	16 (4.2)	0.546	2 (2.6)	3 (3.8)	1.000
Active bleeding	1 (1.1)	2 (0.5)	0.476	1 (1.3)	0	1.000

M-D: Multi-day; S-D: Same-day; SSLE: Scheduled second-look endoscopy.

Table 5 Factors affecting endoscopic submucosal dissection procedure-related postprocedural bleeding, n = 470

Variable	Total, n	PB, n (%)	OR (95%CI)	P value
Male sex	350	17 (4.9)	3.0 (0.8-11.1)	0.105
Age ≤ 60 yr	180	10 (5.6)	1.5 (0.6-4.2)	0.392
ASA score ≤ 2	436	19 (4.4)	2.7 (0.2-38.3)	0.457
ATA usage	45	2 (4.4)	1.7 (0.2-12.7)	0.610
Multi-day discharge group	379	17 (4.5)	1.9 (0.5-7.4)	0.361
Non-flat appearance	28	2 (7.1)	1.4 (0.3-7.6)	0.710
Located in the lower 1/3 of the stomach	106	11 (10.4)	2.1 (0.7-6.2)	0.163
Located in the lower 2/3 of the stomach	211	17 (7.7)	5.3 (1.3-22.2)	0.023
Differentiated type	392	17 (4.3)	1.2 (0.3-5.2)	0.799
Submucosal invasion	92	4 (4.3)	1.3 (0.3-4.7)	0.723
Lesion ≥ 2 cm	236	11 (4.7)	1.2 (0.4-3.8)	0.818
Specimen ≥ 4 cm	234	10 (4.3)	1.1 (0.3-3.7)	0.879

ASA: American Society of Anesthesiologists; ATA: Antithrombotic agents; CI: Confidence interval; OR: Odds ratio; PB: Postprocedural bleeding.