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Kim Y, Na HK, Ahn JY, Lee JH, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Association of local steroid injection as a risk factor for electrocoagulation syndrome after esophageal endoscopic submucosal dissection. Surg Endosc 2024:10.1007/s00464-024-10927-3. [PMID: 38831214 DOI: 10.1007/s00464-024-10927-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Postendoscopic submucosal dissection electrocoagulation syndrome (PEECS) is commonly observed after performing endoscopic submucosal dissection (ESD) for esophageal neoplasia. However, data on the incidence and risk factors for PEECS in the esophagus are lacking due to an unclear definition of PEECS and varied clinical settings. Therefore, we aimed to determine the risk factors for PEECS in patients undergoing ESD for esophageal neoplasia. METHODS We retrospectively reviewed data of relevant clinical and endoscopy-specific parameters from 202 consecutive patients with esophageal neoplasias (139 carcinomas and 63 dysplasias) who underwent ESD under general anesthesia. Esophageal PEECS was defined by satisfying at least two of the following criteria: fever ≥ 37.8 °C, leukocytosis ≥ 10,800/mm3, and localized chest pain ≥ 5/10 points as assessed on a numeric rating scale within 24 h after ESD. Significant factors associated with PEECS were determined by regression analysis. RESULTS PEECS was recorded in 98 of 202 (48.5%) patients. Patients with PEECS exhibited a larger tumor size (25.0 vs. 17.0 mm, P = 0.002), longer procedure (40.0 vs. 29.5 min, P = 0.021) and hemostasis times (5.0 vs. 3.5 min, P = 0.004), required greater submucosal injection volume (60.0 mL vs. 50.0 mL, P = 0.030), and had a lower rate of local steroid injection (4.1% vs. 12.5%, P = 0.029) than those without PEECS. Multivariate regression analysis revealed tumor size ≥ 17 mm (P = 0.047), procedure time ≥ 33 min (P = 0.027), and hemostasis time ≥ 5 min (P = 0.007) as risk factors for PEECS. In addition, local steroid injection was a significant negatively associated factor (P = 0.001). CONCLUSIONS Patients with a large tumor, prolonged procedure and hemostasis times are at a high risk of PEECS occurrence. Further, local steroid injection is a negatively associated factor.
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Affiliation(s)
- Yuri Kim
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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Maselli R, Massimi D, Ferrari C, Mondovì AN, Hassan C, Repici A. Enhanced recovery after surgery (ERAS) in advanced therapeutic flexible endoscopy: Introducing the concept of enhanced recovery after therapeutic endoscopy (ERATE). Dig Liver Dis 2023:S1590-8658(23)01089-7. [PMID: 38161088 DOI: 10.1016/j.dld.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/07/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
Enhanced recovery after surgery (ERAS) guidelines are evidence-based recommendations designed to improve patient outcomes and reduce complications after surgery. Although the ERAS guidelines focus primarily on surgical procedures, many of the principles could be applied also to therapeutic endoscopy as well. An extensive literature research on Embase and PubMed was thus made to reviewed articles regarding ERAS protocols applied to therapeutic endoscopy, organized by specific endoscopic field. Out of 214 papers, only 6 were relevant to the topic. Few studies explored in real life and in trial setting the hypothesized significance of ERAS principles applied to endoscopic procedures, mostly retrospective, not even covering the entire field of therapeutic endoscopy. This field of knowledge appears neglected so far by scientific community and endoscopic organizations. We believe that endoscopy units could benefit anyway from developing and implementing structured enhanced recovery pathways for their patients, therefore we subsequently created and suggested a simply and easily applicable, Enhanced Recovery protocol After Therapeutic Endoscopy which include preoperative preparation, anesthesia and sedation, nausea and vomiting (PONV) prophylaxis, and postoperative care.
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Affiliation(s)
- Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy
| | - Davide Massimi
- IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy.
| | - Chiara Ferrari
- IRCCS Humanitas Research Hospital, Department of Anestesiology, Rozzano, Italy
| | | | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy; IRCCS Humanitas Research Hospital, Department of Gastroenterology, Digestive Endoscopy Unit, Rozzano, Italy
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Li J, Kang G, Liu T, Liu Z, Guo T. Feasibility of Enhanced Recovery After Surgery Protocols Implemented Perioperatively in Endoscopic Submucosal Dissection for Early Gastric Cancer: A Single-Center Retrospective Study. J Laparoendosc Adv Surg Tech A 2023; 33:74-80. [PMID: 35723625 DOI: 10.1089/lap.2022.0269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has advantages over traditional radical gastrectomy. We investigated whether enhanced recovery after surgery (ERAS) protocols are appropriate in the ESD perioperative period. Materials and Methods: We screened 129 consecutive patients, and 12 were excluded. All study patients underwent ESD for EGC. Of the 117 included patients, 57 received traditional perioperative care between January 2017 and December 2018, and 60 patients received perioperative care according to ERAS protocols between January 2019 and September 2020. The primary study endpoint was ESD-related complications. Secondary endpoints included the following postoperative parameters: anal exhaust time, incidence of nausea or vomiting, length of hospitalization, fever rate, abdominal pain on the visual analog scale (VAS), and reported perioperative satisfaction. Results: Complications were comparable between the 2 groups. In the ERAS group, no patients experienced delayed bleeding or perforation. One traditional group patient bled, and one perforated. Postoperative anal exhaust time, nausea or vomiting incidence, hospitalization, fever rate, and VAS pain scores were significantly lower, and perioperative satisfaction rate was significantly higher in the ERAS group. Conclusions: ERAS protocols are both feasible and safe for patients undergoing ESD. ERAS protocols enhance the advantages of ESD for EGC without increasing complications.
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Affiliation(s)
- Junliang Li
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China.,Department of General Surgical, Gansu Provincial Hospital, Lanzhou, China.,The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China
| | - Guolan Kang
- Department of Endoscopic Center, Gansu Provincial Hospital, Lanzhou, China
| | - Tianxiang Liu
- Department of General Surgical, Gansu Provincial Hospital, Lanzhou, China
| | - Zongshu Liu
- Department of General Surgical, Gansu Provincial Hospital, Lanzhou, China
| | - Tiankang Guo
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China.,Department of General Surgical, Gansu Provincial Hospital, Lanzhou, China
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Luo X, An LX, Chen PS, Chang XL, Li Y. Efficacy of dexmedetomidine on postoperative pain in patients undergoing gastric and esophageal endoscopic submucosal dissection: a study protocol for a randomized controlled prospective trial. Trials 2022; 23:491. [PMID: 35698203 PMCID: PMC9195240 DOI: 10.1186/s13063-022-06432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/27/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is widely used as an effective treatment of early gastric and esophageal tumors, as it is minimally invasive, safe, and convenient. Epigastric pain is a common complication of ESD. In the traditional cognition, the postoperative pain of ESD is not serious and does not attach too much attention. However, previous studies found that the incidence of moderate to severe pain after ESD can be as high as 44.9~62.8%. At present, there is no unified understanding of how to carry out good postoperative analgesia in patients undergoing ESD of stomach and esophagus. The purpose of present study is to investigate the efficacy of intraoperative dexmedetomidine (DEX) using on postoperative pain though observing the postoperative visual analog scale (VAS) score within 48 h after ESD surgery, so as to explore an effective analgesia and anesthetic method in patients undergoing gastric and esophagus ESD. METHODS/DESIGN This study is a prospective, single-center, two-arm, randomized control trail. In total, 120 patients undergoing endoscopic submucosal dissection were stratified by type of surgery (i.e., gastric or esophagus ESD) and randomized into two treatment groups, DEX group (group D, n = 60) and control group (group C, n = 60). Patients in the experimental group (DEX group) will be administrated a loading dose of DEX at 1 μg/kg for 15 min and a continuous infusion at 0.6 μg/kg/h until 30 min before the end of operation. In control group, the same volume of normal saline was infused. The primary outcome is VAS at 2 h after ESD surgery. The secondary outcome will be VAS at 1 h, 4 h, 6 h,18 h, 24 h, and 48 h, the status of perioperative hemodynamics, the use of remedial analgesics, sedation score, shivering, postoperative nausea and vomiting (PONV), and satisfaction scores of patient and complication of ESD (such as bleeding, perforation, aspiration pneumonia). DISCUSSION The results of this study will demonstrate that intraoperative application of DEX is beneficial for postoperative pain treatment in patients undergoing ESD. This study will not only confirm that postoperative pain treatment is necessary for patients undergoing ESD but also provides an effective anesthesia method for postoperative analgesia. TRIAL REGISTRATION Chinese Clinical Trial Registry, ID: ChiCTR2100043837 , registered on March 4, 2021, http://www.chictr.org.cn .
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Affiliation(s)
- Xin Luo
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050 China
| | - Li-Xin An
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050 China
| | - Pei-Shan Chen
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050 China
| | - Xin-Lu Chang
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050 China
| | - Yang Li
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050 China
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Takada Y, Hirose T, Nishida K, Kakushima N, Furukawa K, Furune S, Ishikawa E, Sawada T, Maeda K, Yamamura T, Ishikawa T, Ohno E, Nakamura M, Honda T, Ishigami M, Kawashima H, Fujishiro M. Fecal incontinence and oral regurgitation during duodenal endoscopic submucosal dissection using the water pressure method. Dig Endosc 2022; 34:526-534. [PMID: 34185924 DOI: 10.1111/den.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Endoscopic submucosal dissection (ESD) in the duodenum is challenging. The water pressure method (WP-ESD) has been developed with a decreased rate of perforation. However, details of perioperative adverse events of WP-ESD are unknown. The purpose of this study was to clarify the frequency and related factors of fecal incontinence and oral regurgitation during WP-ESD. METHODS A chart-based retrospective analysis was performed on 43 patients who underwent duodenal WP-ESD. The saline volume given into the body was calculated in all cases. All adverse events during WP-ESD until 6 weeks were extracted, and factors related to intraoperative fecal incontinence or oral regurgitation were analyzed. The frequency of fecal incontinence and oral regurgitation was also compared to those of 83 conventional ESD cases. RESULTS In WP-ESD, intraoperative fecal incontinence occurred in 12 (28%), oral regurgitation in six (14%), and aspiration pneumonia in one patient. For fecal incontinence, the infusion speed (saline volume divided by resection time) around 17 mL/min was a significant factor in multivariable analysis. For oral regurgitation, only tumor size was a significant factor in univariate analysis (P = 0.027). Significant difference was observed in the frequency of fecal incontinence between WP-ESD and conventional ESD (28% vs. 0%, P < 0.001), but no difference was observed in oral regurgitation or aspiration pneumonia. CONCLUSIONS Intraoperative fecal incontinence is a unique adverse event of WP-ESD related to the infusion speed. WP-ESD did not pose a risk for oral regurgitation, but we should be aware of the risk in large tumor cases.
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Affiliation(s)
- Yoshihisa Takada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takashi Hirose
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kazuki Nishida
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Aichi, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Satoshi Furune
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tsunaki Sawada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
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6
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Zhu QM, Tu H, Hu B, Wang X. Long-term endoscopic submucosal dissection with postoperative lung injury: a case report. BMC Surg 2021; 21:438. [PMID: 34961512 PMCID: PMC8711203 DOI: 10.1186/s12893-021-01440-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/18/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has been recognized as a safe and minimally invasive technique for the removal of early gastric cancer. Here, we describe a case of extended-duration ESD for a gastric tumor associated with intraoperative perforation and bleeding. Unfortunately, the patient developed acute lung injury (ALI) after the operation. CASE PRESENTATION A 72-year-old woman received ESD for a gastric tumor under general anesthesia. Preoperatively, endoscopic ultrasonography (EUS) showed a 3.1 × 3.5 cm hypoechoic, well-defined mass at the junction of the antrum and body of the stomach on the greater curvature, originating in the muscularis propria layer. During the ESD procedure, when the submucosal mass was stripped, it was found to be closely adhered to the muscular layer and serosa layer, and a full-thickness incision was performed. The abdominal cavity was gradually filled with carbon dioxide gas, and abdominal puncture was performed to reduce intra-abdominal hypertension (IAH). Because the mass adhered to the greater omentum and there was more bleeding during the operation, a long duration of hemostasis and suturing of the wound was required. The whole operation lasted nearly 9 h, and total blood loss was 800 ml. After surgery, acute lung injury was suspected, and the patient was sent to the intensive care unit (ICU) for further treatment. CONCLUSIONS The operation time of ESD and IAH caused by perforation are closely related to a poor prognosis. We should pay attention to the impact of operation time on patients and improve awareness regarding protecting important organ functions.
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Affiliation(s)
- Qian-Mei Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, No. 37 Guoxuexiang, Wuhou District, Chengdu, 610041, Sichuan, China
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, 100021, Beijing, China
| | - Hong Tu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, No. 37 Guoxuexiang, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, No. 37 Guoxuexiang, Wuhou District, 610041, Chengdu, Sichuan, China
| | - Xiao Wang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, No. 37 Guoxuexiang, Wuhou District, Chengdu, 610041, Sichuan, China.
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Mahawongkajit P, Swangsri J. Is General Anesthesia Needed in Endoscopic Submucosal Dissection for Lesions Located in the Mid to Upper Stomach? Clin Endosc 2021; 55:43-44. [PMID: 34788935 PMCID: PMC8831419 DOI: 10.5946/ce.2021.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/14/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Jirawat Swangsri
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Chang JI, Kim TJ, Hwang NY, Sohn I, Min YW, Lee H, Min BH, Lee JH, Rhee PL, Kim JJ. Clinical Outcomes and Adverse Events of Gastric Endoscopic Submucosal Dissection of the Mid to Upper Stomach under General Anesthesia and Monitored Anesthetic Care. Clin Endosc 2021; 55:77-85. [PMID: 34224661 PMCID: PMC8831404 DOI: 10.5946/ce.2021.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/23/2021] [Indexed: 12/05/2022] Open
Abstract
Background/Aims Endoscopic submucosal dissection (ESD) of gastric tumors in the mid-to-upper stomach is a technically challenging procedure. This study compared the therapeutic outcomes and adverse events of ESD of tumors in the mid-to-upper stomach performed under general anesthesia (GA) or monitored anesthesia care (MAC).
Methods Between 2012 and 2018, 674 patients underwent ESD for gastric tumors in the midbody, high body, fundus, or cardia (100 patients received GA; 574 received MAC). The outcomes of the propensity score (PS)-matched (1:1) patients receiving either GA or MAC were analyzed.
Results The PS matching identified 94 patients who received GA and 94 patients who received MAC. Both groups showed high rates ofen bloc resection (GA, 95.7%; MAC, 97.9%; p=0.68) and complete resection (GA, 81.9%; MAC, 84.0%; p=0.14). There were no significant differences between the rates of adverse events (GA, 16.0%; MAC, 8.5%; p=0.18) in the anesthetic groups. Logistic regression analysis indicated that the method of anesthesia did not affect the rates of complete resection or adverse events.
Conclusions ESD of tumors in the mid-to-upper stomach at our high-volume center had good outcomes, regardless of the method of anesthesia. Our results demonstrate no differences between the efficacies and safety of ESD performed under MAC and GA.
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Affiliation(s)
- Jong-In Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Jun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Na Young Hwang
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Insuk Sohn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Ashikari K, Nonaka T, Higurashi T, Takatsu T, Yoshihara T, Misawa N, Arimoto J, Kanoshima K, Matsuura T, Fuyuki A, Ohkubo H, Chiba H, Nakajima A. Efficacy of sedation with dexmedetomidine plus propofol during esophageal endoscopic submucosal dissection. J Gastroenterol Hepatol 2021; 36:1920-1926. [PMID: 33506496 DOI: 10.1111/jgh.15417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/09/2021] [Accepted: 01/23/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM During endoscopic submucosal dissection for superficial esophageal cancer, patient body movement can sometimes occur, which may cause discontinuation of the procedure. Propofol and dexmedetomidine have recently been found to be useful sedatives for endoscopic submucosal dissection. This study investigated whether sedation using propofol plus dexmedetomidine can suppress the patient's body movements during esophageal endoscopic submucosal dissection and compared this combination with sedation using propofol alone. METHODS This was a prospective double-blind randomized controlled trial. Patients with superficial esophageal cancers who underwent esophageal endoscopic submucosal dissection at Yokohama City University Hospital were prospectively enrolled and were randomly assigned to the propofol and the propofol plus dexmedetomidine groups. The primary endpoint was the incidence of restlessness. The secondary endpoints were the satisfaction score, maintenance dose of propofol, and number of rescue propofol injections. RESULTS Sixty-six patients (propofol group: n = 33; combination group: n = 33) were included. The combination group had a significantly lower incidence of restlessness than the propofol group (3.0% vs 27.3%, P = 0.02). In the combination group, the satisfaction scores of the endoscopists were significantly higher, the maintenance dose of propofol was significantly lower, and the number of rescue propofol injections was lower than those in the propofol group (3.0% vs 18.2%, P < 0.001). Although the incidence of bradycardia was significantly higher in the combination group (30.3% vs 3.0%, P < 0.01), no serious adverse effects occurred. CONCLUSION The propofol plus dexmedetomidine combination provided excellent sedation that effectively suppressed the patient's body movements during esophageal endoscopic submucosal dissection.
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Affiliation(s)
- Keiichi Ashikari
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takashi Nonaka
- Department of Gastroenterology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tomohiro Takatsu
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tsutomu Yoshihara
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Noboru Misawa
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Kenji Kanoshima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tetsuya Matsuura
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akiko Fuyuki
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hidenori Ohkubo
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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Tang D, Yuan F, Ma X, Qu H, Li Y, Zhang W, Ma H, Liu H, Yang Y, Xu L, Gao Y, Zhan S. Incidence rates, risk factors, and outcomes of aspiration pneumonia after gastric endoscopic submucosal dissection: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:1457-1469. [PMID: 33242356 DOI: 10.1111/jgh.15359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The risk and prognosis of aspiration pneumonia (AP) after endoscopic submucosal dissection (ESD) are inconsistent among studies. We aim to estimate the incidence, risk factors, and outcome of AP in patients after gastric ESD. METHODS PubMed, EMBASE, Cochrane Library, and Web of Knowledge were searched for relevant articles from inception until April 2020. Data involving the incidence, risk factors, and outcomes were extracted. Pooled incidence, odds ratios (ORs), or standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated. RESULTS Forty records involving 48 674 subjects were finally included. The pooled incidence of AP after gastric ESD was 1.9% (95% CI, 1.2-2.7) via the double arcsine transformation method and 1.6% (1.1-2.5%) via the logit transformation method. Risk factors analyses revealed that old age (OR, 2.52; 95% CI, 1.99-3.18), comorbid pulmonary disease (2.49; 1.66-3.74), comorbid cerebrovascular disease (2.68; 1.05-6.85), remnant stomach (4.91; 1.83-13.14), sedation with propofol (2.51; 1.48-4.28), and long procedural duration (count data: 5.20, 1.25-21.7; measurement data: 1.01, 1.01-1.02) were related to the occurrence of AP. Patients with AP had a longer hospital stay (SMD, 0.56; 95% CI, 0.25-0.87) than those without AP. CONCLUSIONS About 1.9% (1.2-2.7%) of the patients who receive gastric ESD may develop AP, resulting in prolonged hospital stay. More attention should be paid in patients who are older; have comorbidities such as pulmonary diseases, cerebrovascular diseases, or gastric remnant; or require a long procedural duration or deep sedation with propofol.
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Affiliation(s)
- Dong Tang
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Fuxiang Yuan
- Ophthalmologic Center, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Xiaoying Ma
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Haixia Qu
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Yuan Li
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Weiwei Zhang
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Huan Ma
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Haiping Liu
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Yan Yang
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Lin Xu
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Yuqiang Gao
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
| | - Shuhui Zhan
- Department of Gastroenterology, Qingdao Municipal Hospital, the Affiliated Municipal Hospital of Qingdao University, Qingdao, China
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11
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Oh SK, Cho SI, Won YJ, Yun JH. Bilateral tension pneumothorax during endoscopic submucosal dissection under general anesthesia diagnosed by point-of-care ultrasound - A case report. Anesth Pain Med (Seoul) 2021; 16:171-176. [PMID: 33845548 PMCID: PMC8107250 DOI: 10.17085/apm.20088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Endoscopic submucosal dissection has become popular. However, this can cause serious complications. In this case, esophageal perforation caused bilateral tension pneumothorax. CASE A 60-year-old man with esophageal adenoma underwent endoscopic submucosal dissection under general anesthesia. The peak airway pressure was 25 cmH2O after induction but abruptly increased to 40 cmH2O after 30 min. Respiratory sounds were barely heard. The lack of lung sliding in either (right-dominant) lung on ultrasound. Within minutes, oxygen saturation and systolic blood pressure decreased to 52% and 70 mmHg. Emergent needle thoracostomy, followed by chest tube insertion, was performed on right chest and his vital signs stabilized. Upon transfer to intensive care unit, oxygen saturation and blood pressure decreased again; therefore, a left chest tube was inserted. CONCLUSIONS Pneumothorax due to esophageal perforation can lead to life-threatening tension pneumothorax. Anesthesiologists should be aware of the risks and emergency treatment. Ultrasound can be useful for immediate bedside patient-care decisions.
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Affiliation(s)
- Seok Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Inn Cho
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Ju Won
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hee Yun
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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12
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Yamasaki T, Sakata Y, Suekane T, Nebiki H. Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia. Clin Endosc 2020; 54:916-919. [PMID: 33176411 PMCID: PMC8652158 DOI: 10.5946/ce.2020.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 11/14/2022] Open
Abstract
Mallory-Weiss tears (MWT) are occasionally encountered during endoscopic procedures. Esophageal endoscopic submucosal dissection (ESD) is widely performed under general anesthesia to avoid unexpected body movements. We present the case of a 68-year-old woman with squamous cell carcinoma. Although ESD was performed under general anesthesia, a gastric perforation at the MWT caused by gastric inflation was observed after the procedure. The perforation was closed endoscopically, and she was discharged without any sequelae. Although general anesthesia is useful for esophageal ESD, it should be noted that it can cause MWT, and in rare cases, gastric perforation, due to gastric inflation during the procedure.
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Affiliation(s)
- Tomoaki Yamasaki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Yuhei Sakata
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Takehisa Suekane
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
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13
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Heo HJ, Lee JH, Kim YY, Baek SM, Kim KM, Jung DW. Invisible perforation during an endoscopic procedure of the esophagus under general anesthesia
- A case report -. Anesth Pain Med (Seoul) 2020; 15:383-387. [PMID: 33329840 PMCID: PMC7713842 DOI: 10.17085/apm.20034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Endoscopic procedures of the esophagus are more complicated than those of other regions of the gastrointestinal tract. They have a relatively long procedure time and high risk of complications, such as perforation and bleeding. Perforations that occur during the procedure can accompany pneumoperitoneum and pneumomediastinum through leakage of insufflation air and cause severe ventilatory impairment. Case A 58-year-old male patient underwent enucleation of leiomyoma in the esophagus using endoscopy under general anesthesia. Ventilatory impairment occurred 15 min after commencement of the procedure. Subsequently, subcutaneous emphysema and severe abdominal distension were observed. We suggested the possibility of microperforation during the procedure to the endoscopist, and he performed endoscopic clipping around the excision site of leiomyoma. Conclusions Providing anesthetic care by anesthesiologists during endoscopic procedures is considered necessary for patient safety. Complications of endoscopic procedures can be detected and managed early without sequelae during anesthetic care.
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Affiliation(s)
| | - Ji Hye Lee
- Corresponding author: Ji Hye Lee, M.D. Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, 365, Seowon-ro, Wansan-gu, Jeonju 54987, Korea Tel: 82-63-230-1591, Fax: 82-63-230-8919, E-mail:
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14
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Kim SH, Choi YS, Lee SK, Oh H, Choi SH. Comparison of general anesthesia and conscious sedation in procedure-related complications during esophageal endoscopic submucosal dissection. Surg Endosc 2020; 34:3560-3566. [PMID: 32468261 DOI: 10.1007/s00464-020-07663-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/20/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has a favorable outcome, compared to esophagectomy, for early esophageal neoplasia. Recent studies used general anesthesia for esophageal ESD to minimize complications due to insufficient sedation and patient movement. We aimed to evaluate the safety of general anesthesia in comparison with conscious sedation provided by anesthesiologists for esophageal ESD. METHODS We retrospectively reviewed the electronic medical records of 158 patients who underwent esophageal ESD under general anesthesia or conscious sedation provided by anesthesiologists. We evaluated the incidence of procedure-related complications, including perforation, post-ESD bleeding, cardiopulmonary adverse events (arrhythmia, hypotension, and hypoxemia), procedure failure, stricture, and new lung consolidation after ESD. Cases of frank perforation, post-ESD bleeding requiring a vigorous diagnostic approach, and cardiopulmonary adverse events were regarded as acute complications of ESD. RESULTS Acute complications occurred only in the conscious sedation group (8/83 [9.6%] vs. 0/75 [0.0%]; p value = 0.007). The numbers of patients with frank perforation, post-ESD bleeding, and cardiopulmonary adverse events were four, one, and three, respectively. Moreover, new lung consolidation after ESD developed only in the conscious sedation group (7/83 [8.4%] vs. 0/75 [0.0%]; p value = 0.014). ESD failed in four patients in the conscious sedation group. The incidences of stricture that required stent insertion and hospital stay after ESD were comparable between the two groups. CONCLUSION General anesthesia is associated with a lower incidence of acute procedure-related complications in esophageal ESD compared to conscious sedation provided by anesthesiologists. Therefore, we recommend general anesthesia as a safer option for esophageal ESD.
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Affiliation(s)
- Seung Hyun Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Hanseul Oh
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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15
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Yoshizaki T, Obata D, Ueda C, Katayama N, Aoki Y, Okamoto N, Hashimura H, Matsumoto M, Takagi M, Ikeoka S, Yoshida R, Momose K, Eguchi T, Yamashita H, Okada A. Feasibility of the lidocaine injection method during esophageal endoscopic submucosal dissection. JGH Open 2020; 4:251-255. [PMID: 32280773 PMCID: PMC7144770 DOI: 10.1002/jgh3.12257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/19/2019] [Accepted: 08/27/2019] [Indexed: 01/15/2023]
Abstract
Background and Aim Esophageal endoscopic submucosal dissection (ESD) is often technically difficult due to intraoperative body movements. The level of sedation can be increased to suppress body movements, but this may not be successful in all cases. Using local analgesics for submucosal injection during ESD may aid in conscious sedation. This study evaluated the feasibility of the lidocaine injection method (LIM) during esophageal ESD. Methods Twenty‐nine patients with superficial esophageal cancer were enrolled in this study at Osaka Saiseikai Nakatsu Hospital, and 1% lidocaine + 0.4% hyaluronate sodium was injected into the submucosa underneath the lesion during esophageal ESD. The main outcome was body movements that disturbed the procedure. Results Most patients were male (90%), with a median age of 70 years (interquartile range [IQR]: 66–75 years old), and the median lesion size was 17 mm (IQR: 12–21 mm). The median injection volume of lidocaine was 70 mg (IQR: 55–79 mg). All lesions were successfully removed en bloc. In all cases, there were no body movements that disturbed the procedure. Regarding adverse events of sedation, five patients (17%) had hypotension, four patients (14%) had bradycardia, and seven patients (24%) had hypoxemia during ESD. Convulsions or arrhythmia as adverse events associated with lidocaine were not observed. Conclusions Esophageal ESD with LIM did not cause body movements that disturbed the procedure. LIM may help create a stable conscious sedation method for esophageal ESD.
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Affiliation(s)
- Tetsuya Yoshizaki
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Daisuke Obata
- Department of Gastroenterology and Hepatology Kobe Red Cross Hospital Kobe Japan
| | - Chise Ueda
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan.,Department of Gastroenterology and Hepatology Kobe University School of Medicine Kobe Japan
| | - Norio Katayama
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Yasuhiro Aoki
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Norihiro Okamoto
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Hiroki Hashimura
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Masanori Matsumoto
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Megumi Takagi
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Seitaro Ikeoka
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Ryutaro Yoshida
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan.,Department of Gastroenterology and Hepatology Kobe University School of Medicine Kobe Japan
| | - Kenji Momose
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Takaaki Eguchi
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Hiroshi Yamashita
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Akihiko Okada
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
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16
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Liu Y, Chen Y, Shu X, Zhu Y, Li G, Hong J, Song C, Guan Y, Zhou X. Prophylactic antibiotics may be unnecessary in gastric endoscopic submucosal dissection due to the low incidence of bacteremia. Surg Endosc 2019; 34:3788-3794. [DOI: 10.1007/s00464-019-07143-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022]
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17
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Hsu CW, Wu CC, Lee MH, Wang JH, Chen YH, Chang MC. Endoscope rotating technique is useful for difficult colorectal endoscopic submucosal dissection. Surg Endosc 2019; 34:1006-1011. [DOI: 10.1007/s00464-019-07105-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/21/2019] [Indexed: 02/08/2023]
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18
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Yoshio T, Ishiyama A, Tsuchida T, Yoshimizu S, Horiuchi Y, Omae M, Hirasawa T, Yamamoto Y, Sano H, Yokota M, Fujisaki J. Efficacy of novel sedation using the combination of dexmedetomidine and midazolam during endoscopic submucosal dissection for esophageal squamous cell carcinoma. Esophagus 2019; 16:285-291. [PMID: 30937573 DOI: 10.1007/s10388-019-00666-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is the preferred treatment for esophageal squamous cell carcinoma (ESCC). However, ESD can be difficult when patients move due to insufficient sedation. We conducted a prospective confirmatory single arm study to evaluate the efficacy of using dexmedetomidine (DEX) in combination with midazolam as a novel sedation for ESD. METHODS Endoscopic submucosal dissection was performed without intubation in 65 patients. The primary outcome was the proportion of patients who did not move or require restraint during ESD, compared to historical control of ESD performed under midazolam sedation. Secondary outcomes included the frequency of complications and self-report questionnaires from patients and endoscopists. RESULTS Restraint was not required in 97% of patients sedated using the combination of DEX and midazolam. Depressed respiration, low blood pressure, and bradycardia occurred in 23, 37, and 26% of patients, respectively. All patients recovered without severe complication. Occurrence of low blood pressure and bradycardia were higher, while respiratory depression was lower for the combination group than for the historical control group. The amount of midazolam used was significantly lower than in the control. Of note, 94% of patients had no painful sensations, with 3 reporting chest pain and 3 having a recollection of the procedure. Endoscopists were satisfied with the sedation in 94% of cases. All lesions were resected in en bloc fashion, without perforation. CONCLUSIONS The combination of DEX and midazolam provided effective sedation for ESD for ESCC.
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Affiliation(s)
- Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Tsuchida
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masami Omae
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yorimasa Yamamoto
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
- Division of Gastroenterology, Showa University Fujigaoka Hospital, 1-30, Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa, 227-8501, Japan
| | - Hiromi Sano
- Department of Anesthesiology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Miyuki Yokota
- Department of Anesthesiology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
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19
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Hamada K, Kawano K, Yamauchi A, Koyanagi R, Horikawa Y, Nishida S, Shiwa Y, Nishino N, Honda M. Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia. Clin Endosc 2019; 52:252-257. [PMID: 31117339 PMCID: PMC6547345 DOI: 10.5946/ce.2018.151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/23/2018] [Indexed: 01/02/2023] Open
Abstract
Background/Aims Evidence that general anesthesia (GA) reduces the operative time of esophageal endoscopic submucosal dissection (ESD) is currently insufficient. This study aims to evaluate the efficacy and safety of esophageal ESD under GA.
Methods A total of 227 lesions from 198 consecutive patients with superficial esophageal neoplasms treated by ESD at 3 Japanese institutions between April 2011 and September 2017 were included in this retrospective study. For ESD, GA and deep sedation (DS) were used in 102 (51.5%, GA group) and 96 patients (48.5%, DS group), respectively.
Results There were no statistically significant differences in age, sex, or comorbidities between the groups. In the GA group, the tumor size was larger (21 [3–77] mm vs. 14 [3–63] mm, p<0.001), luminal circumference was larger (≥2/3; 13.9% vs. 5.4%, p=0.042), procedure time was shorter (28 [5–202] min vs. 40 [8–249] min, p<0.001), and submucosal dissection speed was faster (25.2 [7.8–157.2] mm2 /min vs. 16.2 [2.4–41.3] mm2 /min, p<0.001). The rates of intraoperative perforation and aspiration pneumonia were lower in the GA group, but the difference did not achieve statistical significance (p=0.242 and p=0.242).
Conclusions GA shortens the procedure time of esophageal ESD.
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Affiliation(s)
- Koichi Hamada
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan.,Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Koichiro Kawano
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | | | - Ryota Koyanagi
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan.,Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Yoshinori Horikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Shinya Nishida
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Yoshiki Shiwa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Noriyuki Nishino
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Surgery, Southern-Tohoku General Hospital, Koriyama, Japan
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20
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Choi SI, Park JC. Commentary on "Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia". Clin Endosc 2019; 52:205-206. [PMID: 31117338 PMCID: PMC6547344 DOI: 10.5946/ce.2019.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Soo In Choi
- Division of Gastroenterology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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21
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van de Ven S, Leliveld L, Klimek M, Hilkemeijer T, Bruno MJ, Koch AD. Propofol sedation without endotracheal intubation is safe for endoscopic submucosal dissection in the esophagus and stomach. United European Gastroenterol J 2019; 7:405-411. [PMID: 31019709 PMCID: PMC6466747 DOI: 10.1177/2050640619831126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/22/2019] [Indexed: 12/23/2022] Open
Abstract
Background Endoscopic submucosal dissection (ESD) for early esophageal and stomach cancer is usually performed under general anesthesia. However, propofol sedation without endotracheal intubation has been suggested as a viable alternative. Objective The objective of this study was to evaluate the safety of propofol sedation without endotracheal intubation during ESD in the upper gastrointestinal tract. Methods We performed a retrospective cohort study of patients who underwent ESD for upper gastrointestinal tumors with propofol-remifentanil analgosedation in a tertiary referral center in the Netherlands between October 2013 and February 2018. Primary endpoints were the rates of intraprocedural endoscopy- and anesthesia-related complications. Secondary endpoints were the postprocedural complication rates within 30 days and endotracheal intubation conversion rates. Results Of 88 patients, intraprocedural ESD-related complications occurred in three patients (3.4%). Intraprocedural anesthesia-related complications occurred in two patients (2.3%), one of whom required conversion to endotracheal intubation. Postprocedural ESD-related complications occurred in 14 patients (15.9%), and minor postprocedural complications occurred in two patients (2.3%). Eighty-two (93.2%) patients were discharged within one day after ESD. No patient was readmitted for anesthesia-related complications. Conclusion Propofol-based sedation without endotracheal intubation is safe for ESD procedures in the esophagus and stomach with low anesthesia-related complication rates and short hospital stay.
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Affiliation(s)
- Sem van de Ven
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - L Leliveld
- Department of Anesthesiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M Klimek
- Department of Anesthesiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Trh Hilkemeijer
- Department of Anesthesiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - A D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Song BG, Min YW, Cha RR, Lee H, Min BH, Lee JH, Rhee PL, Kim JJ. Endoscopic submucosal dissection under general anesthesia for superficial esophageal squamous cell carcinoma is associated with better clinical outcomes. BMC Gastroenterol 2018; 18:80. [PMID: 29879909 PMCID: PMC5992637 DOI: 10.1186/s12876-018-0813-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/31/2018] [Indexed: 02/06/2023] Open
Abstract
Background Endoscopic submucosal dissection (ESD) has been widely accepted for treating superficial esophageal squamous cell carcinoma (SESCC). The aim of this study was to evaluate the efficacy and safety of ESD for SESCC and the effect of different sedation methods on their clinical outcomes. Methods We retrospectively analyzed a total of 169 patients (175 lesions) who underwent ESD for SESCC at Samsung Medical Center, Seoul, South Korea. Short-term and long-term clinical outcomes were evaluated and compared according to the sedation method (conscious sedation [CS] vs general anesthesia [GA]). Results En bloc resection, complete resection, and curative resection (CuR) were achieved in 93.7, 74.9, and 58.9% of cancers, respectively. Perforation and stricture occurred in 8.0 and 12.0% of lesions, respectively. During a mean follow-up period of 33.7 months for survival, 3 (3.0%) patients died without evidence of recurrence after achieving CuR. During a mean follow-up period of 32.5 months for recurrence, 1 (1.0%) patient experienced lymph node metastasis. Synchronous and metachronous cancer were found in 1.0% and in 3.0% of patients, respectively. Multivariate analysis revealed that GA was associated with a higher complete resection rate and a lower perforation rate as compared to CS (odds ratio 3.401, 95% confidence interval 1.317–8.785, P = 0.011 and odds ratio 0.067, 95% confidence interval 0.006–0.775, P = 0.030, respectively). Conclusions ESD is an oncologically effective treatment modality for SESCC, particularly when CuR is achieved. Applying GA for esophageal ESD could improve the clinical outcomes of ESD in patients with SESCC.
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Affiliation(s)
- Byeong Geun Song
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Ra Ri Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
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Min YW. [Endoscopic Treatment for Esophageal Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:116-123. [PMID: 29566472 DOI: 10.4166/kjg.2018.71.3.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Esophageal cancer incidence rate per 100,000 is 4.7 in 2013, which accounts for 1.1% of the total cancer incidence in Korea. Superficial esophageal squamous cell carcinoma is frequently detected in persons undergoing upper endoscopy for gastrointestinal symptoms or for gastric cancer screening. Esophagectomy with lymph node dissection is the standard treatment for esophageal cancer. However, given the considerable morbidity and mortality of esophagectomy, endoscopic resection has become the standard of care for most cases of superficial esophageal squamous cell carcinoma without metastasis. In addition, endoscopic submucosal dissection has increased the cure rate, even when the tumor is large, compared to endoscopic mucosal resection. Thus, endoscopic submucosal dissection is the treatment of choice for superficial esophageal squamous cell carcinoma with a negligible risk of lymph node metastasis. Endoscopic resection is usually associated with a low risk of morbidity and no mortality, and has also shown favorable long-term outcomes. However, the long-term risk of metastasis remains after endoscopic resection, which varies according to the characteristics of tumor. This review describes the indication and outcomes of endoscopic resection, complications of endoscopic resection, and management after treatment.
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Affiliation(s)
- Yang Won Min
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim GE, Lee SH, Chung IS, Lee E, Shin HS, Choi JW. Severe respiratory depression precipitated by unrecognized gastric perforation during endoscopic submucosal dissection under deep sedation - A case report -. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Go-Eun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Sun Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eunji Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Su Shin
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim GE, Kim DK, Choi JW, Chung IS, Jung DW. The safety of endoscopic esophageal procedures under general anesthesia. Korean J Anesthesiol 2017; 70:555-560. [PMID: 29046776 PMCID: PMC5645589 DOI: 10.4097/kjae.2017.70.5.555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND With the increasing demand for general anesthesia for endoscopic esophageal procedures, anesthesiologists should understand the clinical characteristics of post-procedural complications (PPCs). METHODS We retrospectively investigated the incidence of and risk factors associated with PPCs of endoscopic esophageal procedures performed under general anesthesia from July 2013 to November 2016. The final analysis included 129 patients; 114 who underwent esophageal endoscopic dissection for esophageal tumors and 15 cases of peroral endoscopic myotomy for achalasia. Frank perforation during the procedure was defined as an endoscopically recognizable or clinically detected perforation during the procedures. A multivariable logistic regression analysis was conducted to identify independent risk factors for PPCs. RESULTS The overall incidence of PPCs was 19.4% (25/129). All of the PPCs were managed successfully with conservative measures. The most common PPC was symptomatic, radiologically documented atelectasis (11/25, 44.0%), followed by esophageal perforation-related PPCs (symptomatic pneumomediastinum or pneumoperitoneum; 9/25, 36.0%). In the multivariable analysis, frank perforation during the procedure was the only independent risk factor for PPCs (odds ratio, 8.470, 95% CI, 2.051-34.974, P = 0.003). Although frank perforation during the procedure occurred in 13 patients, 38.5% (5/13) of them did not develop any clinical sequelae after their procedures. Compared with patients without PPCs, patients who developed PPCs took longer to their first oral intake and had prolonged hospital stays (P = 0.047 and 0.026, respectively). CONCLUSIONS Iatrogenic perforation during endoscopic esophageal procedures under general anesthesia was the only independent risk factor for PPCs; therefore, proactive measures and close follow-up are necessary.
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Affiliation(s)
- Go Eun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Sun Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Da Woon Jung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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