Association between CT-Diagnosed Pneumonia and Endoscopic Submucosal Dissection of Gastric Neoplasms

Abstract

Background/Aims: This prospective cohort study aimed to elucidate the incidence and characteristics of pneumonia associated with endoscopic submucosal dissection (ESD) of gastric neoplasms using CT. Methods: We included consecutive 188 patients with gastric neoplasms treated with ESD. All patients underwent CT before ESD and the day after ESD. Pneumonia associated with ESD was defined as lung ground glass opacity or consolidation by CT the day after ESD. Results: In 188 patients, 28 patients had diabetes mellitus. Pneumonia was observed by CT in 21 patients (11.2%) after ESD. Of those, 7 patients had diabetes mellitus. By univariate analysis, compared with patients with non-pneumonia complications, risk factors for pneumonia were significantly increased in patients with diabetes mellitus (p = 0.01) and in those who underwent a long procedure time (p = 0.02). By multivariate analysis, pneumonia was significantly increased in patients with diabetes mellitus (OR 4.06, 95% CI 1.35-12.19) and in those who underwent a long procedure time (OR 1.01, 95% CI 1.00-1.02). Conclusions: The incidence of CT-diagnosed pneumonia associated with ESD was relatively high. Furthermore, it was revealed that diabetes mellitus and a long procedure time were risk factors of CT-diagnosed pneumonia.

Incidence rates, risk factors, and outcomes of aspiration pneumonia after gastric endoscopic submucosal dissection: A systematic review and meta‐analysis

“…One study 16 identified male sex to be an independent risk factor for AP (2.835; 1.164–6.909), although the pooled estimates of five studies 11,12,16,19,31 revealed no significant association of sex with AP (1.22; 0.84–1.77; P = 0.30; I 2 = 32%).…”

“…Of these records, 116 were excluded because of duplication, and 264 were excluded after screening for titles and abstracts. After the full‐text screening of the 114 records, 40 records 11–19,31–61 were finally considered eligible for inclusion in this systematic review. The details of the screening and exclusion processes are presented in Figure 1.…”

“…Moreover, several studies have been performed to identify the risk factors and evaluate AP's outcomes, with varied results. For example, although old age was identified as a risk factor for AP after ESD in some studies, 12,15,16 it was not a risk factor in other studies 11,17,18 . Further, few studies reported that AP might prolong hospital stay, 12,16 whereas few other studies revealed that AP did not affect hospitalization 14,17,19 .…”

“…In a systematic review, eight deaths were identified among 292 pulmonary aspirations during gastrointestinal endoscopy in 22 reports 10 . Also, reports have shown that AP after gastric ESD may progress to sepsis 11 or even cause death 12 . Considering these clinically significant adverse outcomes, it is essential to further understand the epidemiology, risk factors, and impact of AP.…”

Predictive Factors of Postendoscopic Submucosal Dissection Electrocoagulation Syndrome and the Utility of Computed Tomography Scan after Esophageal Endoscopic Submucosal Dissection

“…Endoscopic submucosal dissection (ESD) emerged as an endoscopic treatment for gastrointestinal tumors in the 1990s and is now widely used as a beneficial curative therapy owing to its minimal invasiveness and good postoperative outcomes in activities of daily living. The use of ESD for superficial esophageal carcinoma is particularly advantageous in terms of postoperative activities of daily living compared with surgery [1][2][3]; however, a number of procedural accidents, including perforations, can occur during ESD [4][5][6]. The esophagus is anatomically characterized by the absence of a serosa, which means that mediastinal emphysema can occur with ESD, even without perforation [7,8].…”