Abstract
BackgroundThe present study was performed to compare the safety of sedation during endoscopic submucosal dissection (ESD) in the endoscopy room versus operation room.MethodsIn total, 297 patients with gastrointestinal tumors who underwent ESD from January 2011 to December 2016 were retrospectively reviewed. The patients were divided into two groups: those who underwent ESD in the endoscopy room without propofol (Group E) versus operation room with propofol (Group O). The patient, tumor, and procedure characteristics; adverse events; and treatment outcomes were compared between the two groups.ResultsThe patient and tumor characteristics, including age (73.6 ± 8.2 vs. 72.5 ± 9.1 years), comorbidities, and tumor size and histology, were not different between Groups E and O. The ESD procedure time was comparable between Groups E and O (105.4 ± 70.4 vs. 106.5 ± 64.4 min), and the anesthesia time was equivalent (138.3 ± 78.1 vs. 148.4 ± 68.8 min). There were no significant differences in adverse events between the two groups. During the ESD procedure, desaturation occurred significantly more often in Group E than O (12.9% vs. 4.0%, P = 0.021, odds ratio: 3.53, 95% CI: 1.17–14.4). The recovery time after ESD was significantly longer in Group E than O (180 (100–360) vs. 90 (0–180) min, P < 0.001).ConclusionsA decreased desaturation rate and shorter recovery time after ESD were the advantages of sedation in the operation room with propofol compared with sedation in the endoscopy room. These findings warrant further exploration of the advantages of safe and effective ESD for upper gastrointestinal neoplasms in the operation room.
Highlights
The present study was performed to compare the safety of sedation during endoscopic submucosal dissection (ESD) in the endoscopy room versus operation room
The unstable sedation level disturbs the endoscopist, who must concentrate on the ESD procedure [8, 9]
Patients aged >20 years who fulfilled the following criteria were candidates for the study: i) clinical indications for ESD of early esophageal cancer diagnosed as intramucosal squamous cell carcinoma and ii) diagnosis of early gastric cancer according to the absolute indications and expanded indications in the Gastric Cancer Treatment Guidelines [15]
Summary
The present study was performed to compare the safety of sedation during endoscopic submucosal dissection (ESD) in the endoscopy room versus operation room. In Japan, ESD for gastric cancer is usually performed under sedation provided by the endoscopist in the gastrointestinal endoscopy room as described in the Japan Gastroenterological Endoscopy Society guidelines for sedation during gastroenterological endoscopy [5]. In most institutes in Japan, sedation during ESD is performed by intravenous administration of benzodiazepines in combination with opioids [5]. This combination often results in over-sedation and/or difficulty maintaining a stable sedation level. The unstable sedation level disturbs the endoscopist, who must concentrate on the ESD procedure [8, 9]
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