Cho Yong Suk, Shin Sang Youn, Hwang Changhyeok, Seo Jeonghun, Choi Jong Won, Park Byung Kyu, Won Sun Young, Lee Chun Kyon, Lee Yong Kang, Jeon Han Ho
Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Ilsan, Republic of Korea.
Gastroenterol Res Pract. 2017;2017:4723626. doi: 10.1155/2017/4723626. Epub 2017 Jul 9.
Endoscopic submucosal dissection (ESD) is routinely performed in treating gastric neoplasia and requires long-term higher levels of sedation. Endoscopist-directed nurse-administered sedation (EDNAS) has not been well studied in ESD. This study aimed to evaluate the safety and effectiveness of EDNAS for ESD.
Patients treated with ESD for gastric tumors between 2013 and 2015 were retrospectively collected. Patients were divided into a midazolam-treated group (M group) and a midazolam plus propofol-treated group (MP group). Clinical outcome, safety, effectiveness, adverse events of ESD, and adverse events of sedation were analyzed.
Of 209 collected patients, 83 were in the M group and 126 were in the MP group. Of all patients, 67 patients had the circulatory adverse event during the ESD procedure. Sedation method was the only significant risk factor (M versus MP: 2.17 (1.14-4.15), = 0.019). In analysis of MP subgroups, 47 patients suffered an adverse event from sedation, and current smoking was the only significant association factor for adverse event (0.15 (0.03-0.68), = 0.014).
In performing ESD, the effect of sedation is reduced in smoking patients. EDNAS may be acceptable for ESD under careful monitoring of vital sign and oxygen saturation.
内镜黏膜下剥离术（ESD）常用于治疗胃肿瘤，且需要长期较深的镇静。内镜医师指导下由护士实施的镇静（EDNAS）在ESD中的应用尚未得到充分研究。本研究旨在评估EDNAS用于ESD的安全性和有效性。
回顾性收集2013年至2015年间接受ESD治疗胃肿瘤的患者。将患者分为咪达唑仑治疗组（M组）和咪达唑仑联合丙泊酚治疗组（MP组）。分析ESD的临床结局、安全性、有效性、不良事件以及镇静的不良事件。
在收集的209例患者中，M组83例，MP组126例。所有患者中，67例在ESD手术过程中出现循环不良事件。镇静方法是唯一的显著危险因素（M组与MP组比较：2.17（1.14 - 4.15），P = 0.019）。在MP亚组分析中，47例患者出现镇静不良事件，当前吸烟是不良事件的唯一显著相关因素（0.15（0.03 - 0.68），P = 0.014）。
在进行ESD时，吸烟患者的镇静效果会降低。在仔细监测生命体征和血氧饱和度的情况下，EDNAS用于ESD可能是可以接受的。
