Department of Anaesthesiology, Queen Mary Hospital, Hong Kong.
Department of Medicine, The University of Hong Kong, Hong Kong.
Anaesthesiol Intensive Ther. 2023;55(1):9-17. doi: 10.5114/ait.2023.125416.
Endoscopic submucosal dissection (ESD) is an advanced endoscopic procedure for management of gastrointestinal tumours. ESD is usually performed under sedation. However, the use of general anaesthesia (GA) has been hypothesised to improve ESD outcomes. We performed a systematic review and meta-analysis to compare GA against sedation in ESD. A systematic literature search was performed on Cochrane Library, EMBASE and MEDLINE using the terms "General Anaesthesia", "Sedation" and "Endoscopic submucosal dissection". Original articles comparing GA versus sedation in ESD were included. The risk of bias and level of evidence were assessed by validated methods. This review is registered in PROSPERO (CRD42021275813). 176 articles were found in the initial literature search, and 7 articles (comprising 518 patients receiving GA and 495 receiving sedation) were included. Compared with sedation, GA was associated with higher en-bloc resection rates in oesophageal ESD (RR 1.05; 95% CI: 1.00-1.10; I 2 = 65%; P = 0.05). GA patients also trended towards lower rates of gastrointestinal perforation in all ESD procedures (RR 0.62; 95% CI: 0.21-1.82; I 2 = 52%; P = 0.06). Rates of intra- procedural desaturation and post-procedural aspiration pneumonia were lower in GA patients than in patients under sedation. The included studies had a moderate to high risk of bias, and the overall level of evidence was low. GA appears safe and feasible for ESD, yet high-quality trials will be required before GA can be regularly implemented for ESD.
内镜黏膜下剥离术（ESD）是一种用于治疗胃肠道肿瘤的先进内镜手术。ESD 通常在镇静下进行。然而，全身麻醉（GA）的使用被假设可以改善 ESD 结果。我们进行了一项系统评价和荟萃分析，比较 GA 与 ESD 中的镇静作用。我们在 Cochrane Library、EMBASE 和 MEDLINE 上使用“General Anaesthesia”、“Sedation”和“Endoscopic submucosal dissection”等术语进行了系统文献检索。纳入了比较 GA 与 ESD 中镇静作用的原始文章。通过验证方法评估了偏倚风险和证据水平。本综述在 PROSPERO（CRD42021275813）中注册。最初的文献搜索发现了 176 篇文章，纳入了 7 篇文章（包括 518 例接受 GA 和 495 例接受镇静的患者）。与镇静相比，GA 与食管 ESD 中的整块切除率更高相关（RR 1.05；95%CI：1.00-1.10；I 2 = 65%；P = 0.05）。在所有 ESD 手术中，GA 患者的胃肠道穿孔发生率也呈下降趋势（RR 0.62；95%CI：0.21-1.82；I 2 = 52%；P = 0.06）。GA 患者术中低氧血症和术后吸入性肺炎的发生率低于镇静患者。纳入的研究存在中度至高度偏倚风险，总体证据水平较低。GA 似乎对 ESD 安全可行，但需要高质量的试验才能常规实施 GA 用于 ESD。
