Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Saga, Japan.
Department of Internal Medicine, Saga Medical School, Saga, Japan.
Digestion. 2020;101(4):450-457. doi: 10.1159/000500874. Epub 2019 May 24.
BACKGROUND/AIMS: The present study was performed to compare the safety of sedation with propofol during endoscopic submucosal dissection (ESD) for gastric tumors under sedation in the endoscopy room by an endoscopist versus sedation in the operation room by an anesthesiologist.
In total, 638 patients with gastric tumors who underwent ESD from January 2011 to August 2017 at Ureshino Medical Center and Saga Medical Center Koseikan were retrospectively reviewed. The patients were divided into 2 groups: those who underwent ESD in the endoscopy room (Group E, n = 532) and those who underwent ESD in the operation room (Group O, n = 106). Propensity score matching was applied for evaluation. The treatment outcome of ESD and the adverse events of sedation during ESD (desaturation, hypotension, bradycardia, and arrhythmia) were compared between the 2 groups to consider the safety of ESD.
The propensity score-matching analysis created 82 matched pairs. Adjusted comparisons between Groups E and O showed similar treatment outcomes of ESD for gastric tumors. There were no significant differences in the treatment outcomes, anesthesia time, and mean propofol dose between the 2 groups. With respect to adverse events, desaturation occurred more often in Group E than Group O (18.3 vs. 3.7%, respectively; p = 0.005). There were no significant differences in other adverse events (hypotension, bradycardia, and arrhythmia) between the 2 groups.
Sedation with propofol in the operation room might be required to ensure safer application of ESD for gastric tumors. However, a decrease in the desaturation rate was the only disadvantage of sedation in the endoscopy room.
背景/目的：本研究旨在比较内镜下黏膜剥离术（ESD）中，在消化内镜室由内镜医生镇静与在手术室由麻醉医生镇静治疗胃肿瘤的安全性。
回顾性分析 2011 年 1 月至 2017 年 8 月于 Ureshino 医疗中心和佐贺医疗中心 Koseikan 接受 ESD 的 638 例胃肿瘤患者。将患者分为两组：在消化内镜室进行 ESD（E 组，n = 532）和在手术室进行 ESD（O 组，n = 106）。采用倾向评分匹配法进行评估。比较两组 ESD 的治疗结果和 ESD 镇静期间的不良事件（低氧血症、低血压、心动过缓、心律失常），以考虑 ESD 的安全性。
倾向评分匹配分析创建了 82 对匹配。E 组和 O 组调整后的比较显示，胃肿瘤 ESD 的治疗结果相似。两组间治疗结果、麻醉时间和丙泊酚平均剂量无显著差异。在不良事件方面，E 组的低氧血症发生率高于 O 组（18.3% vs. 3.7%，p = 0.005）。两组间其他不良事件（低血压、心动过缓、心律失常）无显著差异。
在手术室使用丙泊酚镇静可能需要确保胃肿瘤 ESD 更安全的应用。然而，在消化内镜室镇静的唯一缺点是低氧血症发生率较高。
