Risk Factors and Prognosis of Pulmonary Complications After Endoscopic Submucosal Dissection for Gastric Neoplasia

Park, Chan Hyuk; Kim, Hyunzu; Kang, Young Ae; Cho, In Rae; Kim, Bun; Heo, Su Jin; Shin, Suji; Lee, Hyuk; Park, Jun Chul; Shin, Sung Kwan; Lee, Yong Chan; Lee, Sang Kil

doi:10.1007/s10620-012-2376-0

Cited by 53 publications

(68 citation statements)

References 25 publications

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“…Our findings were consistent with those of many past reports. However, aspiration pneumonia was more frequent in our study (11.2% of patients) than that reported in previous studies [8,16,17,18]. For instance, Akasaka et al [8] reported that aspiration pneumonia after ESD occurred in 1.6% of patients.…”

Section: Discussioncontrasting

confidence: 70%

“…In their study, chest radiography was performed in cases in which an attending physician suspected postoperative pneumonia based on the clinical symptoms. In addition, Park et al [17] reported that aspiration pneumonia developed in approximately 2.3% of patients. The authors reported that, of all the patients who underwent chest radiography on the day preceding ESD and a day after ESD, 1.1% presented lung consolidation on chest radiography without respiratory signs or symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Park et al [17] demonstrated that risk factors for pneumonia after ESD included the male gender, a procedure time of >2 h, an age of >75 years and a continuous propofol infusion with intermittent or continuous opioid administration. And Kato et al [19] reported that patients aged ≥75 years, cerebrovascular disease and chronic obstructive pulmonary disease were independent risk factors for pneumonia.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…Furthermore, when respiratory depression or unrest occurs with midazolam, the administration of an early dose of flumazenil should be carefully considered. Indeed, continuous propofol infusions with the administration of an opioid and a patient age of over 75 years are independent risk factors for pneumonia after ESD (20). Deterioration of the performance status also increases the risk of aspiration pneumonia after ESD (21).…”

Section: Discussionmentioning

confidence: 99%

“…Deterioration of the performance status also increases the risk of aspiration pneumonia after ESD (21). In a retrospective study (20), 56 of 1,661 patients were diagnosed with pneumonia after ESD. In the present study, none of the elderly patients developed pneumonia, although oxygen administration was required in 57.6% of the cases.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Complications of Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Japanese Patients 75 Years of Age or Older

et al. 2015

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Objective The number of endoscopic submucosal dissection (ESD) procedures for early gastric cancers among patients 75 years of age or older has been increasing. We herein examined both the outcomes and complications of ESD in elderly patients. Methods We investigated the effects of underlying diseases, lesion characteristics, treatment outcomes and complications during and in the postoperative periods of ESD among elderly patients 75 years of age or older versus non-elderly patients less than 75 years of age. Patients A total of 318 early gastric cancers in consecutive 307 patients, all of whom underwent ESD for gastric cancer, were included in this study. Results The number of patients with hypertension and ischemic heart disease was significantly higher in the elderly group than in the non-elderly group. The proportion of lesions with an absolute indication, extended indication or no indication was not significantly different between the groups. During the ESD procedure, the use of atropine sulfate for bradycardia was significantly more frequent in the elderly group. No significant differences were observed between the groups in terms of the treatment for hypertension, oxygen administration or incidence of perforation. In addition, there were no significant differences with respect to oxygen administration, postoperative bleeding or the occurrence of fever and/or pneumonia after the ESD procedure. Conclusion Although bradycardia was more frequently observed in the elderly patients during ESD in this study, ESD was performed safely and managed appropriately, with infrequent postoperative complications. ESD appears to be effective, even in elderly patients.

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Opioid Analgesics and the Risk of Serious Infections Among Patients With Rheumatoid Arthritis: A Self‐Controlled Case Series Study

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Griffin

Stein

et al. 2016

Arthritis & Rheumatology

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Objective Animal and in vitro studies suggest that certain opioid analgesics impair crucial immune functions. We sought to determine if opioid use is associated with an increased risk of serious infections in patients with rheumatoid arthritis (RA). Methods We conducted a self-controlled case series analysis on a retrospective cohort of 13,796 patients with RA enrolled in Tennessee Medicaid (1995–2009). We performed within-person comparisons of the risk of hospitalizations for serious infections during periods of opioid use compared with non-use using conditional Poisson regression. Fixed confounders were accounted for by design, and time-varying confounders included age, the use of disease-modifying anti-rheumatic drugs, glucocorticoids and proton-pump inhibitors. Additional analyses examined new opioid use, use of opioids known to have immunosuppressive properties, long acting opioid use, and different opioid dosages. Sensitivity analyses accounted for potential protopathic bias and confounding by indication. Results Among 1,790 patients with RA who had at least one hospitalization for serious infection, the adjusted incidence rate of serious infection was higher during periods of current opioid use compared with non-use [incidence rate ratio (IRR): 1.39 (95% confidence interval (CI): 1.19–1.62)]. The incidence rate was also higher during periods of long-acting opioid use, immunosuppressive opioid use and new opioid use compared with non-use [IRR: 2.01 (95% CI: 1.52–2.66); IRR: 1.72 (95% CI: 1.33–2.23); IRR: 2.38 (95% CI: 1.65–3.42), respectively]. Results of sensitivity analyses were consistent with the main findings. Conclusions In within-person comparisons of patients with RA, opioid use was associated with an increased risk of hospitalizations for serious infection.

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Risk Factors and Prognosis of Pulmonary Complications After Endoscopic Submucosal Dissection for Gastric Neoplasia

Abstract: Deep sedation under continuous propofol infusion with opioid injection during ESD may be a risk factor for pneumonia.

Cited by 53 publications

References 25 publications

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

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

Perioperative Complications of Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Japanese Patients 75 Years of Age or Older

Opioid Analgesics and the Risk of Serious Infections Among Patients With Rheumatoid Arthritis: A Self‐Controlled Case Series Study

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