IDDF2018-ABS-0071 Comparison of propofol sedation between the endoscopy room and operation room during endoscopic submucosal dissection for gastric tumour: a propensity score matching analysis

Abstract

Background Propofol, a short-acting sedative characterised by rapid recovery, has several advantages including induction of an appropriate sedation level and relative ease of safely maintaining this level. These advantages have led to a worldwide increase in the application of propofol for standard endoscopic procedures. Previous studies recommended the use of continuous propofol sedation for endoscopic submucosal dissection (ESD), but endoscopists must also give instructions for sedation while carrying out ESD procedures, because of the absence of the anesthesiologist in the endoscopy room in Japan. The present study was performed to compare the safety of sedation using propofol during ESD in the endoscopy room versus the operation room. Methods In total, 639 patients with gastric tumours who underwent ESD from January 2011 to August 2017 at Ureshino Medical Centre and Saga-Ken Medical Centre Koseikan were retrospectively reviewed. The patients were divided into two groups: those who underwent ESD in the endoscopy room (Group E; n=534) versus operation room (Group O; n=105). Propensity score matching was used to compensate for the differences in age, sex, tumour size, procedure time, anaesthesia time and total propofol dose. The treatment outcome of ESD and the adverse events (desaturation, hypotension, bradycardia and arrhythmia) of sedation during ESD were evaluated between two groups. Results Propensity score matching analysis created 91 matched pairs. Adjusted comparisons between Group E and O showed similar treatment outcomes of ESD (en bloc resection rate: 98.9% vs. 100%, p=1.000; perforation rate: 4.4% vs. 1.1%, p=0.368; delayed haemorrhage rate: 8.8% vs. 2.2%, p=0.100). In adverse events, desaturation occurred significantly more often in Group E than O (16.5% vs. 3.3%, p=0.005). There were no significant differences in other adverse events between the two groups (hypotension rate: 13.2% vs. 7.7%, p=0.333, bradycardia rate: 5.5% vs. 1.1%, p=0.211, and arrhythmia rate: 0% vs. 0%, p=1.000). Conclusions Whereas a decrease in the desaturation rate was the only advantages of sedation with propofol in the operation room, sedation in the operation room might be required to ensure safer application of ESD for gastric tumours.