Endoscopic submucosal dissection (ESD) has been widely performed for the treatment of gastric neoplasm. The purpose of this study was to investigate scale, trends, and outcomes of gastric adenoma patients who underwent ESD using a Korean national claims database from 2011-2014. METHODS:

We used Korean health insurance data from the period between November 1, 2011 to December 31, 2014 for analysis. ESD was identified with procedural and material codes of the Health Insurance Review and Assessment Service in Korea. We analyzed treatment patterns, length of stay, total medical costs, en-bloc resection and treatment status after ESD by hospital type. RESULTS:

A total of 24,703 patients treated by ESD for those diagnosed with gastric adenoma during the study period were identified. There were 2,079 patients in 2011(Nov-Dec only), 7,224 in 2012, 7,871 in 2013 and 8,166 in 2014. ESD treatments for gastric adenoma were performed 56% of the time in tertiary-care hospitals, 41% in general hospitals and 3% in institutions.

In 2014, the median length of stay and total medical costs respectively, were 5 days and KRW 1,378,100.

The en-bloc resection rate was above 98%, regardless of the year or the hospital in question.

Among 24,703 gastric adenoma patients treated by ESD, a total of 260(1%) patients were diagnosed with gastric adenocarcinoma after ESD for adenoma, within this study period. CONCLUSIONS:

The ESD procedure of gastric adenoma has steadily increased over time since reimbursement was allowed in 2011. Besides, approximately 1% of patients were diagnosed with gastric adenocarcinoma after treatment for gastric adenoma by ESD resection via en-bloc methods. For early detection of gastric adenocarcinoma, screening and close follow-up with patients with adenoma, after ESD, is warranted.