Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Department of Anesthesiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
United European Gastroenterol J. 2019 Apr;7(3):405-411. doi: 10.1177/2050640619831126. Epub 2019 Feb 16.
Endoscopic submucosal dissection (ESD) for early esophageal and stomach cancer is usually performed under general anesthesia. However, propofol sedation without endotracheal intubation has been suggested as a viable alternative.
The objective of this study was to evaluate the safety of propofol sedation without endotracheal intubation during ESD in the upper gastrointestinal tract.
We performed a retrospective cohort study of patients who underwent ESD for upper gastrointestinal tumors with propofol-remifentanil analgosedation in a tertiary referral center in the Netherlands between October 2013 and February 2018. Primary endpoints were the rates of intraprocedural endoscopy- and anesthesia-related complications. Secondary endpoints were the postprocedural complication rates within 30 days and endotracheal intubation conversion rates.
Of 88 patients, intraprocedural ESD-related complications occurred in three patients (3.4%). Intraprocedural anesthesia-related complications occurred in two patients (2.3%), one of whom required conversion to endotracheal intubation. Postprocedural ESD-related complications occurred in 14 patients (15.9%), and minor postprocedural complications occurred in two patients (2.3%). Eighty-two (93.2%) patients were discharged within one day after ESD. No patient was readmitted for anesthesia-related complications.
Propofol-based sedation without endotracheal intubation is safe for ESD procedures in the esophagus and stomach with low anesthesia-related complication rates and short hospital stay.
内镜黏膜下剥离术（ESD）治疗早期食管和胃癌通常在全身麻醉下进行。然而，有人提出在不进行气管插管的情况下使用异丙酚镇静作为可行的替代方案。
本研究旨在评估在荷兰的一家三级转诊中心，使用异丙酚-瑞芬太尼镇静进行上消化道 ESD 期间，不进行气管插管的安全性。
我们对 2013 年 10 月至 2018 年 2 月期间在荷兰一家三级转诊中心接受 ESD 治疗上消化道肿瘤的患者进行了一项回顾性队列研究。主要终点是内镜和麻醉相关并发症的术中发生率。次要终点是 30 天内的术后并发症发生率和气管插管转换率。
88 例患者中，3 例（3.4%）发生术中 ESD 相关并发症。2 例（2.3%）发生术中麻醉相关并发症，其中 1 例需要转换为气管插管。14 例（15.9%）发生术后 ESD 相关并发症，2 例（2.3%）发生轻微术后并发症。82 例（93.2%）患者在 ESD 后 1 天内出院。无患者因麻醉相关并发症再次入院。
对于食管和胃的 ESD 手术，使用异丙酚镇静而不进行气管插管是安全的，具有较低的麻醉相关并发症发生率和较短的住院时间。
