Sedation methods can determine performance of endoscopic submucosal dissection in patients with gastric neoplasia

Park, Chan Hyuk; Min, Jae Hoon; Yoo, Young Chul; Kim, Hyunzu; Joh, Dong Hoo; Jo, Jung Hyun; Shin, Suji; Lee, Hyuk; Park, Jun Chul; Shin, Sung Kwan; Lee, Yong Chan; Lee, Sang Kil

doi:10.1007/s00464-013-2804-z

Cited by 40 publications

(32 citation statements)

References 30 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: 56%

“…Recently, Park et al [18] reported that sedation with continuous propofol infusion during ESD was higher than that with intermittent midazolam injection, with or without propofol in en bloc resection and complete resection. Conversely, aspiration pneumonia was more frequent in the group receiving continuous propofol infusion than in the group receiving intermittent midazolam injection.…”

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: 56%

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…Another key factor for success in this study may have been the participation of an anesthesiologist in all of the procedures because a previous report indicated that sedation administered by an anesthesiologist improved the en bloc resection rate and reduced the procedure time. 45 A large ESD series has reported SM fibrosis in 20% of the cases with mild F1 and severe F2 in 62% and 38% of those cases, respectively. 29 Similarly, our study revealed SM fibrosis in 24% of the cases with F2 cases accounting for 10 (77%) of the total number of 13 SM fibrosis cases probably due to aggressive or bite-on-bite preoperative biopsy 44 as well as the inclusion of 2 local recurrence cases.…”

Section: Discussionmentioning

confidence: 98%

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video)

Emura¹,

Mejía²,

Donneys³

et al. 2015

Gastrointestinal Endoscopy

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“…Although ESD is generally accepted as a safe treatment, it carries some risks for elderly patients with comorbidities because of the long procedure time (with deep sedation) and procedure-related complications [24][25][26][27][28]. Therefore, in considering the indications for ESD in elderly patients, we must keep in mind their general condition, including the severity of comorbidities and PS score.…”

Section: Discussionmentioning

confidence: 99%

Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older

et al. 2016

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Background Only a few studies have reported long-term outcomes for endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) in elderly patients. The aim of this study was to evaluate the efficacy of ESD for EGC in elderly patients C75 years with respect to both short-and long-term outcomes. Methods We reviewed the clinical data of elderly patients C75 years who had undergone ESD for EGC at Tonan Hospital from January 2003 to May 2010. Results A total of 177 consecutive patients, including 145 with curative resection (CR) and 32 with noncurative resection (non-CR), were examined. Of the 32 patients with non-CR, 15 underwent additional surgery, and lymph node metastases were found in 3 patients. The remaining 17 patients were followed without additional surgery because of advanced age or poor general condition. Procedure-related complications, such as post-ESD bleeding, perforation and pneumonia, were within the acceptable range. The 5-year survival rates of patients with CR, those with additional surgery after non-CR, and those without additional surgery after non-CR were 84.6, 73.3, and 58.8 %, respectively. No deaths were attributable to the original gastric cancer; patients succumbed to other illnesses, including malignancy and respiratory disease. ConclusionsIn elderly patients, ESD is an acceptable treatment for EGC in terms of both short-and longterm outcomes. Careful clinical assessment of elderly patients is necessary before ESD. After ESD, medical follow-up is important so that other malignancies and diseases that affect the elderly are not overlooked.

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Sedation methods can determine performance of endoscopic submucosal dissection in patients with gastric neoplasia

Abstract: Sedation with CPIA can improve ESD performance.

Cited by 40 publications

References 30 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

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video)

Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older

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