Clin Endosc.  2022 Jan;55(1):77-85. 10.5946/ce.2021.002.

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

• Chang JI
• Kim TJ
• Hwang NY
• Sohn I
• Min YW
• Lee H
• Min BH
• Lee JH
• Rhee PL
• Kim JJ

• KMID: 2525053
• DOI: http://doi.org/10.5946/ce.2021.002

Abstract

Background/Aims
Endoscopic submucosal dissection (ESD) of gastric tumors in the mid-to-upper stomach is a technically challenging procedure. This study compared the therapeutic outcomes and adverse events of ESD of tumors in the mid-to-upper stomach 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 (100 patients received GA; 574 received MAC). The outcomes of the propensity score (PS)-matched (1:1) patients receiving either GA or MAC were analyzed.
Results
The PS matching identified 94 patients who received GA and 94 patients who received MAC. Both groups showed high rates 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 were no significant differences between the rates of adverse events (GA, 16.0%; MAC, 8.5%; p=0.18) in the anesthetic groups. Logistic regression 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 method of anesthesia. Our results demonstrate no differences between the efficacies and safety of ESD performed under MAC and GA.

Keyword

Anesthesia; Early gastric cancer; Endoscopic submucosal dissection

Figure

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  Fig. 1. Flow diagram for the selection of the study patients. ESD, endoscopic submucosal dissection.

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  Fig. 2. Endoscopic submucosal dissection procedure. (A) On the posterior wall of the high body, a 1.2-cm flat elevated mucosal lesion was noticed. (B) After the indigo carmine solution was sprayed for the visualization of the lesion, the lesion was marked with a needle knife. (C) Circumferential mucosal cutting was performed with a needle knife. (D) After submucosal injection of a mixture of normal saline, epinephrine, and indigo carmine, the submucosal layer was dissected with an IT2 knife. (E) A procedure-induced artificial ulcer was observed. (F) The resected specimen was fixed on a board for pathologic examination.

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