The impact of sarcopenia on adverse events associated with gastric endoscopic submucosal dissection

Objective. There is no consensus regarding administration of propofol for performing endoscopic submucosal dissection (ESD) in patients with comorbidities. The aim of this study was to evaluate the safety and efficacy of propofol-induced sedation administered by nonanesthesiologists during ESD of gastric cancer in patients with comorbidities classified according to the American Society of Anesthesiologists (ASA) physical status. Methods. Five hundred and twenty-two patients who underwent ESD for gastric epithelial tumors under sedation by nonanesthesiologist-administrated propofol between April 2011 and October 2017 at Dokkyo Medical University Hospital were enrolled in this study. The patients were divided into 3 groups according to the ASA physical status classification. Hypotension, desaturation, and bradycardia were evaluated as the adverse events associated with propofol. The safety of sedation by nonanesthesiologist-administrated propofol was measured as the primary outcome. Results. The patients were classified according to the ASA physical status classification: 182 with no comorbidity (ASA 1), 273 with mild comorbidity (ASA 2), and 67 with severe comorbidity (ASA 3). The median age of the patients with ASA physical status of 2/3 was higher than the median age of those with ASA physical status of 1. There was no significant difference in tumor characteristics, total amount of propofol used, or ESD procedure time, among the 3 groups. Adverse events related to propofol in the 522 patients were as follows: hypotension (systolic blood pressure<90 mmHg) in 113 patients (21.6%), respiratory depression (SpO2<90%) in 265 patients (50.8%), and bradycardia (pulse rate<50 bpm) in 39 patients (7.47%). There was no significant difference in the incidences of adverse events among the 3 groups during induction, maintenance, or recovery. No severe adverse event was reported. ASA 3 patients had a significantly longer mean length of hospital stay (8 days for ASA 1, 9 days for ASA 2, and 9 days for ASA 3, P=0.003). However, the difference did not appear to be clinically significant. Conclusions. Sedation by nonanesthesiologist-administrated propofol during ESD is safe and effective, even for at-risk patients according to the ASA physical status classification.

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Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta‐analysis

Journal of Gastroenterology and Hepatology ◽

10.1111/jgh.15148 ◽

2020 ◽

Vol 35 (11) ◽

pp. 1869-1877

Author(s):

Mingqing Liu ◽

Yangyu Zhang ◽

Yueqi Wang ◽

He Zhu ◽

Hong Xu

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

Meta Analysis ◽

Submucosal Dissection ◽

Colorectal Endoscopic Submucosal Dissection

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Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.07.034 ◽

2015 ◽

Vol 81 (3) ◽

pp. 583-595 ◽

Cited By ~ 132

Author(s):

Mikihiro Fujiya ◽

Kazuyuki Tanaka ◽

Tatsuya Dokoshi ◽

Motoya Tominaga ◽

Nobuhiro Ueno ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

Meta Analysis ◽

Colon Neoplasms ◽

Submucosal Dissection

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Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.104 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 104-104

Author(s):

Hyungchul Park ◽

Do Hoon Kim ◽

Eun Jeong Gong ◽

Hee Kyong Na ◽

Ji Yong Ahn ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

Survival Rates ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Female Ratio ◽

Submucosal Dissection ◽

Difficult Procedure ◽

Male To Female

104 Background: Endoscopic submucosal dissection (ESD) of a superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ESD to determine its feasibility and effectiveness for the treatment of SEN. Methods: Patients who underwent ESD for SEN between August 2005 and June 2014 were eligible for this study. The clinical features of patients and tumors, histopathologic characteristics, adverse events, results of endoscopic resection, and survival were investigated. Results: ESD was performed in 225 patients with 261 lesions, including 70 cases (26.8%) of dysplasias and 191 cases (73.2%) of squamous cell carcinomas. The median age was 65 years (range: 44–86 years), and the male to female ratio was 21.5:1. Median tumor size was 37 mm (range: 5–85 mm) and median procedure time was 45 minutes (range: 9–160 minutes). En bloc resection was performed in 245 of 261 lesions (93.9%), with complete resection in 234 lesions (89.7%) and curative resection in 201 lesions (77.0%). Adverse events occurred in 33 cases (12.6%), including bleeding (1.5%), perforation (4.6%), and stricture (6.5%). During a median follow-up period of 35.0 months (interquartile range: 18–62 months), none of the patients showed local recurrence. The 5-year overall and disease-specific survival rates were 89.7% and 100%, respectively. Conclusions: ESD is a feasible and effective procedure for the treatment of SEN based on our 10-year experience, which showed favorable outcomes.

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Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

Gastroenterology Research and Practice ◽

10.1155/2017/6395283 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Byeong Gu Song ◽

Gwang Ha Kim ◽

Bong Eun Lee ◽

Hye Kyung Jeon ◽

Dong Hoon Baek ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

Partial Gastrectomy ◽

Remnant Stomach ◽

Complete Resection ◽

Incomplete Resection ◽

En Bloc ◽

Submucosal Dissection ◽

Single Center Experience ◽

Epithelial Neoplasms

Aims. To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy. Methods. This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events. Results. The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6–58 months), there was no recurrence in any case. Conclusions. ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines.

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Scissor-type knife improves the safety of endoscopic submucosal dissection (ESD) among endoscopists without experience in ESD: a randomized ex vivo study

Endoscopy International Open ◽

10.1055/a-1487-5469 ◽

2021 ◽

Vol 09 (08) ◽

pp. E1207-E1213

Author(s):

Kavel Visrodia ◽

Tarek Sawas ◽

Liam Zakko ◽

Juan Reyes Genere ◽

Cadman Leggett ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

Muscle Injury ◽

Ex Vivo ◽

En Bloc Resection ◽

Bloc Resection ◽

Lower Proportion ◽

Procedure Time ◽

En Bloc ◽

Submucosal Dissection

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is technically challenging, difficult to learn, and carries a substantial risk of perforation, all of which remain significant barriers to its adoptability. We aimed to determine whether use of a novel scissor-type knife improved efficacy and safety among novice performers of ESD. Materials and methods Following a brief didactic session on ESD, participants performed ESD of two lesions (2 cm diameter) in an ex vivo porcine gastric model. One resection was performed with a conventional knife and the other with the scissor knife (order of knife randomized). We recorded procedure time, successful en bloc resection, and adverse events (including full-thickness perforation and muscle injury) for each dissection. Participants completed a post-study survey. Results 10 endoscopists (8 trainees, 2 staff) considered novices in ESD participated. Compared with the conventional knife, use of the scissor knife was associated with a significantly shorter time to completion of submucosal dissection (mean 6.2 [SD 5.6] vs. 15.6 [SD 15.6] minutes; P = 0.04) and total procedure time was not significantly different (22.1 [SD 13.3] vs. 24.9 [SD 26.5] minutes; P = 0.65). Scissor knife use was also associated with a significantly lower proportion of perforation and/or muscle injury (10.0 % vs. 70.0 %; P < 0.01) and proportion of muscle injury alone (10.0 % vs. 60.0 %; P = 0.02). Conclusions Among novices performing ESD on an ex vivo animal model, use of a scissor knife was associated with a significantly lower proportion of adverse events without prolonging procedure time. Scissor-type knives may improve ESD safety, at least among novices.

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Clinical Outcomes and Adverse Events of Gastric Endoscopic Submucosal Dissection of the Mid to Upper Stomach under General Anesthesia and Monitored Anesthetic Care

Clinical Endoscopy ◽

10.5946/ce.2021.002 ◽

2021 ◽

Author(s):

Jong-In Chang ◽

Tae Jun Kim ◽

Na Young Hwang ◽

Insuk Sohn ◽

Yang Won Min ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

General Anesthesia ◽

Clinical Outcomes ◽

Anesthetic Care ◽

Submucosal Dissection

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Long-term endoscopic submucosal dissection with postoperative lung injury: a case report

BMC Surgery ◽

10.1186/s12893-021-01440-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qian-Mei Zhu ◽

Hong Tu ◽

Bing Hu ◽

Xiao Wang

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Endoscopic Submucosal Dissection ◽

Operation Time ◽

Gastric Tumor ◽

Greater Omentum ◽

Invasive Technique ◽

Submucosal Dissection ◽

Abdominal Hypertension ◽

The Impact

Abstract Background Endoscopic submucosal dissection (ESD) has been recognized as a safe and minimally invasive technique for the removal of early gastric cancer. Here, we describe a case of extended-duration ESD for a gastric tumor associated with intraoperative perforation and bleeding. Unfortunately, the patient developed acute lung injury (ALI) after the operation. Case presentation: A 72-year-old woman received ESD for a gastric tumor under general anesthesia. Preoperatively, endoscopic ultrasonography (EUS) showed a 3.1 × 3.5 cm hypoechoic, well-defined mass at the junction of the antrum and body of the stomach on the greater curvature, originating in the muscularis propria layer. During the ESD procedure, when the submucosal mass was stripped, it was found to be closely adhered to the muscular layer and serosa layer, and a full-thickness incision was performed. The abdominal cavity was gradually filled with carbon dioxide gas, and abdominal puncture was performed to reduce intra-abdominal hypertension (IAH). Because the mass adhered to the greater omentum and there was more bleeding during the operation, a long duration of hemostasis and suturing of the wound was required. The whole operation lasted nearly 9 h, and total blood loss was 800 ml. After surgery, acute lung injury was suspected, and the patient was sent to the intensive care unit (ICU) for further treatment. Conclusions The operation time of ESD and IAH caused by perforation are closely related to a poor prognosis. We should pay attention to the impact of operation time on patients and improve awareness regarding protecting important organ functions.

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