EUS development in China: Results from national surveys in 2013 and 2020

Abstract

Background and objectives: EUS has recently gained attraction in mainland China. This study aimed to evaluate the development of EUS from results of two national surveys.

Methods: EUS-related information, including infrastructure, personnel, volume, and quality indicator, was extracted from the Chinese Digestive Endoscopy Census. Data from 2012 and 2019 were compared, and differences among various hospitals and regions were analyzed. The EUS rates (EUS annual volume per 100,000 inhabitants) between China and developed countries were also compared.

Results: The number of hospitals performing EUS in mainland China increased from 531 to 1236 (2.33-fold), and 4025 endoscopists performed EUS in 2019. The volumes of all EUS and interventional EUS increased from 207,166 to 464,182 (2.24-fold) and 10,737 to 15,334 (1.43-fold), respectively. The EUS rate in China was lower than that in developed countries but showed a higher growth rate. EUS rate varied substantially among different provincial regions (in 2019: 4.9-152.0 per 100,000 inhabitants) and showed significant positive association with gross domestic product per capita (in 2019: r = 0.559, P = 0.001). The EUS-FNA-positive rate in 2019 was comparable between hospitals in terms of annual volume (≥50 or < 50: 79.9% vs. 71.6%, P = 0.704) and practice duration (starting EUS-FNA before or after 2012: 78.7% vs. 72.6%, P = 0.565).

Conclusion: EUS has developed considerably in China in recent years but still needs substantial improvement. More resources are in demand for hospitals in less-developed regions and with low EUS volume.

Keywords: EUS; development status; national census; quality.

Figure 1

Estimated EUS rates in China (mainland) and developed countries (per 100,000 inhabitants)

Figure 2

Development of EUS rate (number of EUS per 100,000 inhabitants in a year) in 4 economic regions of mainland China between 2012 and 2019 (This map does not show the complete territory of China)

Figure 3

Scatter plot depicting the correlation between EUS rate and GDP per capita in 31 provincial regions of mainland China in 2012 and 2019 (blue points, 2012: r = 0.618, P < 0.001; red points, 2019: r = 0.559, P = 0.001). Both x- and y-axes of the graph have a different scale after the breaks (//and \\). AH: Anhui; BJ: Beijing; CQ: Chongqing; FJ: Fujian; GS: Gansu; GD: Guangdong; GX: Guangxi; GZ: Guizhou; IM: Inner Mongolia; HaN: Hainan; HeB: Hebei; HL: Heilongjiang; HeN: Henan; HuB: Hubei; HuN: Hunan; JS: Jiangsu; JX: Jiangxi; JL: Jilin; LN: Liaoning; NX: Ningxia; QH: Qinghai; SD: Shandong; SH: Shanghai; ShX: Shaanxi; SX: Shanxi; SC: Sichuan; TJ: Tianjin; XZ: Tibet; XJ: Xinjiang; YN: Yunnan; ZJ: Zhejiang; GDP, gross domestic productss