#925 - Endoscopic Submucosal Dissection (ESD) in colon - Nordic Casemix Centre - nordcaseforum

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#925 - Endoscopic Submucosal Dissection (ESD) in colon

Status:

Closed

Assignee:

Author:

Birna Björg Másdóttir

Task type:

Questions and answers

Priority:

Minor

Start date:

2024-04-23

Spent time:

0.00 h

Created:

2024-04-23 15:54

Closed:

2025-09-03 14:18

Initiator:

Iceland

MDC:

Owner / responsible:

Case type:

Target Grouper:

MoreLess

Description

Endoscopic submucosal dissection (ESD) is a minimally invasive procedure to remove growths from the lining of the gastrointestinal (GI) tract without surgery. It may offer a cure for early-stage cancers of the esophagus, stomach and colon. This is an expensive procedure - time consuming and uses very precise and expensive electrosurgical knife. An ESD is an evolution of an older technique called endoscopic mucosal resection (EMR). ESD is more expensive, difficult and time consuming than EMR.

Iceland is now starting to use this ESD treatment. Are other countries using it also, and how is it grouped there? A possible DRG group might be 703O Endoscopic insertion of stent or ablation treatment of gastrointestinal tract, short therapy. Now, only endoscopic treatments of esophagus and stomach group into 703O.

Any comments would be appreciated.

Attachments (1)

(1-1/1)

Kristiina Kahur 2024-04-24 12:29

Nordic Casemix Centre/Kristiina Kahur 24-4-2024

Countries are invited to share their experience regarding ESD.

We will discuss this issue in EG Autumn meeting together with other open Q&As.

Kristiina Kahur 2024-09-09 12:53

2024-09-04 Expert Group

This topic was discussed in the EG meeting. There are new EDS codes to be added to the Finnish version. The grouping features of the codes will be discussed and reported on task #929.

This task will remain active for further updates.

Kristiina Kahur 2025-01-29 15:44

Nordic Casemix Centre/Kristiina Kahur 29-1-2025

This is to summarize the situation with endoscopic submucosal dissection (ESD) in NordDRG 2025PR versions.

There are three national versions (ICE, FIN and SWE) having ESD codes in their def.tables. The codes are determined based on anatomical location.

In total, there are five different ESD codes:

JCSA14 Endoscopic submucosal dissection in the esophagus (in SWE, FIN and ICE version)
JDSA46 Endoscopic submucosal dissection in the stomach (FIN and ICE)
JFSA44 Endoscopic submucosal dissection in the small intestine (SWE)
JFSA87 Endoscopic submucosal dissection in the large bowel (FIN and ICE)
JGSA14 Endoscopic submucosal dissection in the rectum (SWE, FIN, ICE)

Apart from OR value which is 2 for all codes, and PROCPR 40V78 Code not compatible with follow-up which is used only in SWE version, the other grouping features (PROCPRs) of each code vary:

JCSA14    Endoscopic submucosal dissection in the esophagus (swe/fin/ice)
PROCPR    03E06    Therapeutic endoscopy of upper gastrointestinal tract for ENMT problem
PROCPR    03S12    Other ear, nose, mouth or throat OR procedure
PROCPR    04S02    Other respiratory system OR procedure
PROCPR    06E06    Therapeutic endoscopy of upper gastrointestinal tract for gastrointestinal problem
PROCPR    06S10    Other digestive system OR procedure
PROCPR    14S90    Significant operation for obstetrical patient
PROCPR    17E06    Other therapeutic endoscopy of upper gastrointestinal tract for myeloproliferative diseases

JDSA46    Endoscopic submucosal dissection in the stomach (fin/ice)
PROCPR    06E06    Therapeutic endoscopy of upper gastrointestinal tract for gastrointestinal problem
PROCPR    06S10    Other digestive system OR procedure
PROCPR    17E06    Other therapeutic endoscopy of upper gastrointestinal tract for myeloproliferative diseases

JFSA44    Endoscopic submucosal dissection in the small intenstine (swe)
PROCPR    06E04    Therapeutic enteroscopy
PROCPR    06S06    Small or large bowel procedure
PROCPR    17E04    Therapeutic enteroscpy for myeloproliferative disease

JFSA87    Endoscopic submucosal dissection in the large bowel (fin/ice)
PROCPR    06E10    Colonoscopy for gastrointestinal diseases
PROCPR    06S06    Small or large bowel procedure
PROCPR    17E10    Colonoscopy for myeloproliferative disease

JGSA14    Endoscopic submucosal dissection in the rectum (swe/fin/ice)
PROCPR    06E10    Colonoscopy for gastrointestinal diseases
PROCPR    06S06    Small or large bowel procedure
PROCPR    17E10    Colonoscopy for myeloproliferative disease

The grouping features are to large extent the same compared to respective codes for endoscopic mucosal or submucosal resection (EMR) which means that the assignment of cases to DRGs is similar regardless of method (EMR or ESD).

Given that ESD and EMR are different in terms of resource use it would be very much appreciated if any of the countries which has cost data could conduct an analysis and share the results before the EG meeting to facilitate the further revision and changes of grouping features of ESD codes.

Mats Fernström 2025-02-11 18:51

Mats Fernström, the National Board of Health and Welfare, Sweden, 2025-02-11 (SWE ID C1036)

I add Swedish cost data for 2023 (it is the latest we have). We included occurrence of ESD and corresponding EMR regardless of DRG. There were only 60 cases with occurrence of ESD in the medical records.

As far as I can see, ESD in total is just a little more expensive than EMR in oesophagus and stomach, but in colon, however, EMR is more expensive than ESD.

Based on our Swedish data, I see no strong reason to make changes in the grouping logic.

Attachment Swedish data C1036.xlsx added

Kristiina Kahur 2025-03-24 16:12

2025-03-11 Expert group

This case was discussed in the EG meeting.

Case remains open for further analysis when sufficient data is available. For any changes, TCs will be shared by the countries.

Status changed from Active to Further active

Kristiina Kahur 2025-09-03 14:18

2025-09-02 Expert group

This case was discussed during EG meeting and it was decided to close the case.

Status changed from Further active to Closed

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