Clinical Outcomes and Adverse Events of Gastric Endoscopic Submucosal Dissection of the Mid to Upper Stomach under General Anesthesia and Monitored Anesthetic Care
2
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Background/Aims: Endoscopic submucosal dissection (ESD) of gastric tumors in the mid-to-upper stomach is a technicallychallenging procedure. This study compared the therapeutic outcomes and adverse events of ESD of tumors in the mid-to-upperstomach performed under general anesthesia (GA) or monitored anesthesia care (MAC). Methods: Between 2012 and 2018, 674 patients underwent ESD for gastric tumors in the midbody, high body, fundus, or cardia (100patients received GA; 574 received MAC). The outcomes of the propensity score (PS)-matched (1:1) patients receiving either GA orMAC were analyzed. Results: The PS matching identified 94 patients who received GA and 94 patients who received MAC. Both groups showed highrates of en bloc resection (GA, 95.7%; MAC, 97.9%; p=0.68) and complete resection (GA, 81.9%; MAC, 84.0%; p=0.14). There wereno significant differences between the rates of adverse events (GA, 16.0%; MAC, 8.5%; p=0.18) in the anesthetic groups. Logisticregression analysis indicated that the method of anesthesia did not affect the rates of complete resection or adverse events. Conclusions: ESD of tumors in the mid-to-upper stomach at our high-volume center had good outcomes, regardless of the methodof anesthesia. Our results demonstrate no differences between the efficacies and safety of ESD performed under MAC and GA.
Abstract
Background/Aims: Endoscopic submucosal dissection (ESD) of gastric tumors in the mid-to-upper stomach is a technicallychallenging procedure. This study compared the therapeutic outcomes and adverse events of ESD of tumors in the mid-to-upperstomach performed under general anesthesia (GA) or monitored anesthesia care (MAC). Methods: Between 2012 and 2018, 674 patients underwent ESD for gastric tumors in the midbody, high body, fundus, or cardia (100patients received GA; 574 received MAC). The outcomes of the propensity score (PS)-matched (1:1) patients receiving either GA orMAC were analyzed. Results: The PS matching identified 94 patients who received GA and 94 patients who received MAC. Both groups showed highrates of en bloc resection (GA, 95.7%; MAC, 97.9%; p=0.68) and complete resection (GA, 81.9%; MAC, 84.0%; p=0.14). There wereno significant differences between the rates of adverse events (GA, 16.0%; MAC, 8.5%; p=0.18) in the anesthetic groups. Logisticregression analysis indicated that the method of anesthesia did not affect the rates of complete resection or adverse events. Conclusions: ESD of tumors in the mid-to-upper stomach at our high-volume center had good outcomes, regardless of the methodof anesthesia. Our results demonstrate no differences between the efficacies and safety of ESD performed under MAC and GA.
참고문헌 (18)
- Yurtlu DA, "Propofol-based sedation versus general anesthesia for endoscopic submucosal dissection", Medicine(Baltimore), 95, pp.e3680~ (2016)
- Nonaka S, "Safety and effectiveness of propofol-based monitored anesthesia care without intubation during endoscopic submucosal dissection for early gastric and esophageal cancers", Dig Endosc, 27, pp.665~673 (2015)
- Kim JH, "Risk factors associated with difficult gastric endoscopic submucosal dissection : predicting difficult ESD", Surg Endosc, 31, pp.1617~1626 (2017)
- Nishiyama N, "Endoscopic submucosal dissection for neoplasia of the greater curvature of the upper and middle stomach : j-shaped superficial cutting and splashed dissection", J Gastrointestin Liver Dis, 28, pp.397~404 (2019)
- Kang DH, "Location characteristics of early gastric cancer treated with endoscopic submucosal dissection", Surg Endosc, 31, pp.4673~4679 (2017)
- Kiriyama S, "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, pp.831~837 (2010)
- Wadhwa V, "Similar risk of cardiopulmonary adverse events between propofol and traditional anesthesia for gastrointestinal endoscopy : a systematic review and meta-analysis", Clin Gastroenterol Hepatol, 15, pp.194~206 (2017)
- Park CH, "Assessing the stability and safety of procedure during endoscopic submucosal dissection according to sedation methods : a randomized trial", PLoS One, 10, pp.e0120529~ (2015)
- Yamaguchi D, "Comparison of sedation between the endoscopy room and operation room during endoscopic submucosal dissection for neoplasms in the upper gastrointestinal tract", BMC Gastroenterol, 17, pp.127~ (2017)
- Yamashita K, "Efficacy and safety of endoscopic submucosal dissection under general anesthesia", World J Gastrointest Endosc, 8, pp.466~471 (2016)
- Facciorusso A, "Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer : a meta-analysis", World J Gastrointest Endosc, 6, pp.555~563 (2014)
- Il Ju Choi, "Short-Term Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Prospective Multicenter Cohort Study", Gut and Liver, 10(5), pp.739~748 (2016), 거트앤리버 소화기연관학회협의회
- Yoo JH, "Risk factors for perforations associated with endoscopic submucosal dissection in gastric lesions : emphasis on perforation type", Surg Endosc, 26, pp.2456~2464 (2012)
- Oda I, "Endoscopic submucosal dissection for early gastric cancer : technical feasibility, operation time and complications from a large consecutive series", Dig Endosc, 17, pp.54~58 (2005)
- Mannen K, "Risk factors for complications of endoscopic submucosal dissection in gastric tumors : analysis of 478lesions", J Gastroenterol, 45, pp.30~36 (2010)
- Toyokawa T, "Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms : analysis of 1123 lesions", J Gastroenterol Hepatol, 27, pp.907~912 (2012)
- Song BG, "Endoscopic submucosal dissection under general anesthesia for superficial esophageal squamous cell carcinoma is associated with better clinical outcomes", BMC Gastroenterol, 18, pp.80~ (2018)
- Boulos NM, "Monitored anesthesia care is associated with a decrease in morbidity after endovascular angioplasty in aortoiliac disease", J Cardiothorac Vasc Anesth, 34, pp.2440~2445 (2020)