S1038 Sedation – Only Gastric Endoscopic Submucosal Dissection – A Single Center Experience

Abstract

Introduction: Data regarding the efficacy and safety of sedation-only endoscopic submucosal dissection (ESD) in the upper gastrointestinal (GI) tract is scarce. We aimed to study the efficacy and safety of sedation-only ESD in the upper GI tract. Methods: This was a retrospective analysis of 26 consecutive ESD cases from 4/2019 till 05/2021, that were performed in our advanced endoscopy center. Data was gathered from our electronic medical records. During ESD a sedation (midazolam) and/or analgesia (dipyridamole) was used. We evaluated the incidence of procedure-related complications, including bleeding, perforation, need for emergency surgery and cardio-pulmonary adverse events associated with sedation. Data regarding lesion pathology (surface size, type, location), ESD procedure (duration, lifting solution) were also recorded. In all procedures an Olympus DualKnife J was used. Results: Mean age of patients was 75.8 years +/- 8.8 years. 14/26 patients were female. Based on American Society of Anaesthesiologists’ (ASA) classification of Physical Health, 2 patients were ASA 1, 20 patients ASA 2 and 4 patients ASA 3. During the procedure a low dose of midazolam median 2.0 mg, IQR [0.5 – 4.0 mg]) was used with the addition of analgesia (dipyridamole) median 7.5 mg [IQR 3.8 – 10.3 mg]. During the procedure, patients were monitored with pulse oximetry. There were no cardiopulmonary adverse events in our group. 2 perforations and 1 delayed bleeding were treated endoscopically with the use of endoscopically placed clips. EleviewTM (Aries Pharmaceuticals, Inc.) or OriseTM (Boston Scientific) were used as lifting agents. Bleeding during procedures was managed with hemostatic forceps. Median procedure time was 136 minutes [IQR: 101 – 193 minutes]. ESD was performed in 21 cases (80.8%), and hybrid technique with snare was used in 5 cases (19.2%). R0 resection was achieved in 22 cases (84.6%). Median surface size of the lesions was 9.0 cm2 [IQR: 8.3 – 18.3 cm2]. R0 resection was achieved in 22 (84.6%) cases. Median length of hospital stay was 2 days.Table 1.: Demographics and procedure characteristics. IQR interquartile range, ESD endoscopic submucosal dissection, R0 resection. Conclusion: The results of our cohort study show that sedation-only gastric ESD is safe and efficacious.