Top

Published in:

01-08-2013

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

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

Published in: Surgical Endoscopy | Issue 8/2013

Abstract

Background

Although proper sedation is mandatory for endoscopic procedures such as endoscopic submucosal dissection (ESD), there is no research investigating the effects of sedation on ESD performance and complications. We aimed to evaluate the relationship among sedation methods, clinical outcomes, and complications after ESD for gastric neoplasia.

Methods

We retrospectively reviewed clinical data of 1,367 patients with 1,485 lesions who had undergone ESD for gastric adenoma or early gastric cancer at our tertiary teaching hospital in Seoul, Korea, between January 2008 and May 2011. Of these, 1,035 lesions in 958 patients were included in the intermittent midazolam/propofol injection by endoscopists (IMIE) group, and 450 lesions in 409 patients were included in the continuous propofol infusion with opioid administration by anesthesiologists (CPIA) group.

Results

En bloc resection and complete resection rates were higher in the CPIA group than in the IMIE group (CPIA vs. IMIE; en bloc resection, 99.8 and 95.0 %, P < 0.001; complete resection, 94.2 and 88.3 %, P < 0.001). Duration of procedure was shorter in the CPIA group than in the IMIE group (CPIA vs. IMIE; 48.2 ± 32.5 and 57.6 ± 41.3 min, P < 0.001). In multivariate analysis, sedation method was an independent factor associated with en bloc resection and complete resection. Additionally, sedation with CPIA was not a risk factor for bleeding (P = 0.403) or perforation (P = 0.474); however, aspiration pneumonia developed more frequently in patients sedated with CPIA (CPIA vs. IMIE, 4.4 and 1.5 %, P = 0.002).

Conclusions

Sedation with CPIA can improve ESD performance.

Miyamoto S, Muto M, Hamamoto Y, Boku N, Ohtsu A, Baba S, Yoshida M, Ohkuwa M, Hosokawa K, Tajiri H, Yoshida S (2002) A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms. Gastrointest Endosc 55:576–581PubMedCrossRef

Gotoda T, Yamamoto H, Soetikno RM (2006) Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 41:929–942PubMedCrossRef

Akasaka T, Nishida T, Tsutsui S, Michida T, Yamada T, Ogiyama H, Kitamura S, Ichiba M, Komori M, Nishiyama O, Nakanishi F, Zushi S, Nishihara A, Iijima H, Tsujii M, Hayashi N (2011) Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by Osaka University ESD Study Group. Dig Endosc 23:73–77PubMedCrossRef

Yamagata T, Hirasawa D, Fujita N, Suzuki T, Obana T, Sugawara T, Ohira T, Harada Y, Maeda Y, Koike Y, Suzuki K, Noda Y (2011) Efficacy of propofol sedation for endoscopic submucosal dissection (ESD): assessment with prospective data collection. Intern Med 50:1455–1460PubMedCrossRef

Lee H, Yun WK, Min BH, Lee JH, Rhee PL, Kim KM, Rhee JC, Kim JJ (2011) A feasibility study on the expanded indication for endoscopic submucosal dissection of early gastric cancer. Surg Endosc 25:1985–1993PubMedCrossRef

Ahn JY, Jung HY, Choi KD, Choi JY, Kim MY, Lee JH, Choi KS, Kim do H, Song HJ, Lee GH, Kim JH, Park YS (2011) Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 74:485–493PubMedCrossRef

Cohen LB, Wecsler JS, Gaetano JN, Benson A, Miller KM, Durkalski V, Aisenberg J (2006) Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 101:967–974PubMedCrossRef

Horiuchi A, Nakayama Y, Hidaka N, Ichise Y, Kajiyama M, Tanaka N (2009) Low-dose propofol sedation for diagnostic esophagogastroduodenoscopy: results in 10,662 adults. Am J Gastroenterol 104:1650–1655PubMedCrossRef

Cote GA, Hovis RM, Ansstas MA, Waldbaum L, Azar RR, Early DS, Edmundowicz SA, Mullady DK, Jonnalagadda SS (2010) Incidence of sedation-related complications with propofol use during advanced endoscopic procedures. Clin Gastroenterol Hepatol 8:137–142PubMedCrossRef

10.

Riphaus A, Rabofski M, Wehrmann T (2010) Endoscopic sedation and monitoring practice in Germany: results from the first nationwide survey. Z Gastroenterol 48:392–397PubMedCrossRef

11.

Bo L, Bai Y, Bian J, Wen P, Li J, Deng X (2011) Propofol vs traditional sedative agents for endoscopic retrograde cholangiopancreatography: a meta-analysis. World J Gastroenterol 17:3538–3543PubMedCrossRef

12.

Kiriyama S, Gotoda T, Sano H, Oda I, Nishimoto F, Hirashima T, Kusano C, Kuwano H (2010) Safe and effective sedation in endoscopic submucosal dissection for early gastric cancer: a randomized comparison between propofol continuous infusion and intermittent midazolam injection. J Gastroenterol 45:831–837PubMedCrossRef

13.

Aisenberg J, Cohen LB, Piorkowski JD (2007) Propofol use under the direction of trained gastroenterologists: an analysis of the medicolegal implications. Am J Gastroenterol 102:707–713PubMedCrossRef

14.

Matsui N, Akahoshi K, Nakamura K, Ihara E, Kita H (2012) Endoscopic submucosal dissection for removal of superficial gastrointestinal neoplasms: a technical review. World J Gastrointest Endosc 4:123–136PubMedCrossRef

15.

Ho W, Yen C, Lan C, Lin C, Yong S, Hwang K, Chou M (2012) Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study. BMC Gastroenterol 12:164PubMedCrossRef

16.

Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma. 3rd English edition. Gastric Cancer 14:101–112CrossRef

17.

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140PubMedCrossRef

18.

Vargo J, Zuccaro G, Dumot JA, Shermock KM, Morrow JB, Conwell DL, Trolli PA, Maurer WG (2002) Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology 123:8–16PubMedCrossRef

19.

Walker JA, McIntyre RD, Schleinitz PF, Jacobson KN, Haulk A, Adesman P, Tolleson S, Parent R, Donnelly R, Rex DK (2003) Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center. Am J Gastroenterol 98:1744–1750PubMedCrossRef

20.

Sasaki T, Tanabe S, Azuma M, Sato A, Naruke A, Ishido K, Katada C, Higuchi K, Koizumi W (2012) Propofol sedation with bispectral index monitoring is useful for endoscopic submucosal dissection: a randomized prospective phase II clinical trial. Endoscopy 44:584–589PubMedCrossRef

21.

Qadeer MA, Vargo J, Khandwala F, Lopez R, Zuccaro G (2005) Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis. Clin Gastroenterol Hepatol 3:1049–1056PubMedCrossRef

22.

Wehrmann T, Triantafyllou K (2010) Propofol sedation in gastrointestinal endoscopy: a gastroenterologist’s perspective. Digestion 82:106–109PubMedCrossRef

23.

Miyata M, Yokoyama Y, Okoyama N, Joh T, Seno K, Sasaki M, Ohara H, Nomura T, Kasugai K, Itoh M (2000) What are the appropriate indications for endoscopic mucosal resection for early gastric cancer? Analysis of 256 endoscopically resected lesions. Endoscopy 32:773–778PubMedCrossRef

24.

Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226PubMedCrossRef

25.

Park Y, Cho E, Kang H, Kim J (2011) The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc 25:2666–2677PubMedCrossRef

26.

Isomoto H, Ohnita K, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Akiyama M, Ozawa E, Nakao K, Kohno S, Shikuwa S (2010) Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol 22:311–317PubMedCrossRef

27.

Lee IL, Wu CS, Tung SY, Lin PY, Shen CH, Wei KL, Chang TS (2008) Endoscopic submucosal dissection for early gastric cancers: experience from a new endoscopic center in Taiwan. J Clin Gastroenterol 42:42–47PubMedCrossRef

28.

Bleach NR (1993) The gag reflex and aspiration: a retrospective analysis of 120 patients assessed by videofluoroscopy. Clin Otolaryngol Allied Sci 18:303–307PubMedCrossRef

29.

Tagaito Y, Isono S, Nishino T (1998) Upper airway reflexes during a combination of propofol and fentanyl anesthesia. Anesthesiology 88:1459–1466PubMedCrossRef

30.

Yoshida H, Ayuse T, Ishizaka S, Ishitobi S, Nogami T, Oi K (2007) Management of exaggerated gag reflex using intravenous sedation in prosthodontic treatment. Tohoku J Exp Med 212:373–378PubMedCrossRef

Title: Sedation methods can determine performance of endoscopic submucosal dissection in patients with gastric neoplasia
Authors: Chan Hyuk Park
Jae Hoon Min
Young-Chul Yoo
Hyunzu Kim
Dong Hoo Joh
Jung Hyun Jo
Suji Shin
Hyuk Lee
Jun Chul Park
Sung Kwan Shin
Yong Chan Lee
Sang Kil Lee
Publication date: 01-08-2013
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-2804-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2013

Incision-related outcome after live donor nephrectomy: a single-center experience

Randomized clinical trial of fibrin glue versus tacked fixation in laparoscopic groin hernia repair

Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection?

Does Roux-en-Y gastrectomy for gastric cancer influence glucose homeostasis in lean patients?

Laparoscopic aneurysm resection and splenectomy for splenic artery aneurysm in the third trimester of pregnancy

Right or left first during bilateral thoracoscopy?