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

 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 
 Surgical Endoscopy , Vol.27(8) : 2760-2767, 2013 
Journal Title
 Surgical Endoscopy  
Issue Date
Conscious Sedation/methods* ; Dissection/methods* ; Endoscopy, Gastrointestinal/methods* ; Female ; Follow-Up Studies ; Gastric Mucosa/pathology ; Gastric Mucosa/surgery* ; Humans ; Male ; Middle Aged ; Pain Management/methods* ; Pain Measurement ; Patient Satisfaction ; Retrospective Studies ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery* ; Treatment Outcome
Endoscopic submucosal dissection ; Midazolam ; Propofol ; Sedation
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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyun Ju(김현주)
Min, Jae Hoon(민재훈)
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Park, Chan Hyuk(박찬혁)
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Yoo, Young Chul(유영철) ORCID logo https://orcid.org/0000-0002-6334-7541
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hyuk(이혁)
Joh, Dong Hoo(조동후)
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