Nationwide Claims-Based Incidence and Associated Factors of Adverse Events after Gastric Endoscopic Submucosal Dissection

Background/Aims: Most data on adverse events (AEs) following gastric endoscopic submucosal dissection (ESD) originate from high-volume expert centers, limiting their generalizability to routine clinical practice. Population-level claims-based evidence on AEs after gastric ESD remains limited, although such data cannot fully account for lesion- and procedure-specific risk factors. Methods: We conducted a nationwide, retrospective cohort study using claims data from the Korean Health Insurance Review and Assessment Service. All patients who underwent ESD for gastric neoplastic lesions between 2013 and 2017 were included. Claims-defined AEs-including bleeding, perforation, pneumonia, and intensive care unit (ICU) admission within 30 days-were assessed, along with subsequent gastric surgery within 90 days. Multivariable logistic regression was used to identify factors associated with each outcome. Results: A total of 83,871 gastric ESD procedures were performed in 76,181 patients. The incidence of bleeding was 16.6%, whereas perforation (0.17%), pneumonia (0.65%), and ICU admission (0.94%) were uncommon. Older age was associated with a lower risk of bleeding but a higher risk of pneumonia and ICU admission, particularly among patients aged ≥80 years. Among the antithrombotic agents included in the analysis, warfarin was associated with bleeding and clopidogrel was associated with ICU admission. Procedures performed at general hospitals were associated with higher risks of multiple AEs compared with those performed at tertiary centers. Overall, 3.9% of patients underwent additional gastric surgery, almost exclusively among those with gastric cancer. Conclusions: In this nationwide population-based claims study, claims-defined AEs after standard-indication gastric ESD were associated with patient-level and institution-level variables available in administrative data (cris.nih.go.kr, KCT0011604).