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Impact of BMI on Complications of Gastric Endoscopic Submucosal Dissection

 Na Young Kim  ;  Hye Sun Lee  ;  Ki-Young Lee  ;  Soyoung Jeon  ;  Seung Yeon Choi  ;  Hye Ji Joo  ;  Ji Eun Kim  ;  So Yeon Kim 
 DIGESTIVE DISEASES, Vol.39(4) : 301-309, 2021-06 
Journal Title
Issue Date
Adult ; Aged ; Body Mass Index* ; Endoscopic Mucosal Resection / adverse effects* ; Gastric Mucosa / surgery* ; Humans ; Incidence ; Logistic Models ; Male ; Middle Aged ; Obesity / complications* ; Obesity / physiopathology ; Postoperative Complications / epidemiology ; Postoperative Complications / etiology* ; Retrospective Studies ; Treatment Outcome
BMI ; Complication ; Endoscopic submucosal dissection ; Gastric neoplasm
Background: Gastric endoscopic submucosal dissection (ESD) has a high rate of complications. However, it is unclear whether BMI affects ESD complications. We aimed to investigate the impact of BMI on ESD complications.

Methods: A total of 7,263 patients who underwent gastric ESD were classified into 3 groups according to the Asia-Pacific classification of BMI: normal (BMI <23 kg/m2, n = 2,466), overweight (BMI 23-24.9 kg/m2, n = 2,117), and obese (BMI ≥25 kg/m2, n = 2,680). Adjusted logistic regression analyses were conducted to assess the association between BMI and ESD complications.

Results: Compared to the normal group, a lower incidence of perforation and a higher incidence of pneumonia and leukocytosis were found in the overweight and obese groups, and intra-ESD desaturation and hypertension were more frequent in the obese group. After adjustment for confounders, the risk of perforation significantly decreased in the overweight (odds ratio [OR] = 0.24, 95% confidence interval [CI]: 0.17-0.33) and obese (OR = 0.12, 95% CI: 0.08-0.18) groups compared to that in the normal group. Meanwhile, the risk of pneumonia significantly increased in the overweight (OR = 11.04, 95% CI: 6.31-19.31) and obese (OR = 10.71, 95% CI: 6.14-18.66) groups compared to the normal group. During sedation, the obese group had a significantly increased risk of desaturation (OR = 2.81, 95% CI: 1.18-6.69) and hypertension (OR = 1.35, 95% CI: 1.11-1.63) compared to the normal group.

Conclusions: High BMI was significantly associated with ESD complications. More caution is needed in cases of obese patients undergoing ESD.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Na Young(김나영) ORCID logo https://orcid.org/0000-0003-3685-2005
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Lee, Ki Young(이기영) ORCID logo https://orcid.org/0000-0003-4893-3195
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
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