Abstract
BackgroundAlthough endoscopic submucosal dissection (ESD) is routinely performed under sedation, the difference in ESD performance according to sedation method is not well known. This study attempted to prospectively assess and compare the satisfaction of the endoscopists and patient stability during ESD between two sedation methods.MethodsOne hundred and fifty-four adult patients scheduled for ESD were sedated by either the IMIE (intermittent midazolam/propofol injection by endoscopist) or CPIA (continuous propofol infusion by anesthesiologist) method. The primary endpoint of this study was to compare the level of satisfaction of the endoscopists between the two groups. The secondary endpoints included level of satisfaction of the patients, patient’s pain scores, events interfering with the procedure, incidence of unintended deep sedation, hemodynamic and respiratory events, and ESD outcomes and complications.ResultsLevel of satisfaction of the endoscopists was significantly higher in the CPIA Group compared to the IMIE group (IMIE vs. CPIA; high satisfaction score; 63.2% vs. 87.2%, P=0.001). The incidence of unintended deep sedation was significantly higher in the IMIE Group compared to the CPIA Group (IMIE vs. CPIA; 17.1% vs. 5.1%, P=0.018) as well as the number of patients showing spontaneous movement or those requiring physical restraint (IMIE vs. CPIA; spontaneous movement; 60.5% vs. 42.3%, P=0.024, physical restraint; 27.6% vs. 10.3%, P=0.006, respectively). In contrast, level of satisfaction of the patients were found to be significantly higher in the IMIE Group (IMIE vs. CPIA; high satisfaction score; 85.5% vs. 67.9%, P=0.027). Pain scores of the patients, hemodynamic and respiratory events, and ESD outcomes and complications were not different between the two groups.ConclusionContinuous propofol and remifentanil infusion by an anesthesiologist during ESD can increase the satisfaction levels of the endoscopists by providing a more stable state of sedation.Trial RegistrationClinicalTrials.gov NCT01806753
Highlights
Since it was first developed in the late 1990s, endoscopic submucosal dissection (ESD) has gained much popularity and has been proven to be superior to endoscopic mucosal resection (EMR) by showing higher rates of en-bloc resection in larger tumors and in expanded indications for endoscopic resection of early gastric cancer [1]
One hundred and fifty-four adult patients scheduled for ESD were sedated by either the IMIE or CPIA method
Sedation for Endoscopic Submucosal Dissection patients were found to be significantly higher in the IMIE Group (IMIE vs. CPIA; high satisfaction score; 85.5% vs. 67.9%, P=0.027)
Summary
Since it was first developed in the late 1990s, endoscopic submucosal dissection (ESD) has gained much popularity and has been proven to be superior to endoscopic mucosal resection (EMR) by showing higher rates of en-bloc resection in larger tumors and in expanded indications for endoscopic resection of early gastric cancer [1]. This study concluded that continuous propofol infusion supplemented with opioid administration by anesthesiologists improved ESD performance by increasing en bloc resection and complete resection rates and reducing procedure time, compared to intermittent bolus injection of midazolam and propofol by endoscopists. These results were largely attributed to the enhanced stability of the procedure by a decrease in patient movement and other events that may interrupt a smooth intervention, and a general increase in the satisfaction of the endoscopists was assumed with continuous propofol infusion used by the anesthesiologists. This study attempted to prospectively assess and compare the satisfaction of the endoscopists and patient stability during ESD between two sedation methods.
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