Abosheaishaa Hazem, Abdallfatah Abdallfatah, Abdelghany Abdelmalek, Sethi Arshia, Ismail Abdellatif, Mohamed Doha, Aboeldahb Moataz, Abdelhalim Omar, Mohamed Islam, Azzam Ahmed Y, Essibayi Muhammed Amir, Altschul David J, Nassar Mahmoud, Bilal Mohammad
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, NY, USA.
Faculty of Medicine, October 6 University, Giza, Egypt.
ASIDE Gastroenterol. 2025 May;1(1):7-14. doi: 10.71079/aside.gi.0109257. Epub 2025 Mar 11.
Endoscopic submucosal dissection (ESD) is a technique for removing dysplastic lesions in the gastrointestinal tract but carries risks like pain and perforation. Dexmedetomidine, an α2-receptor agonist, offers potential benefits as an adjunct sedative during ESD by providing anxiolysis and analgesia. This systematic review and meta-analysis assesses its efficacy and safety.
We searched databases including Embase, Medline/PubMed, Scopus, and Web of Science up to April 21, 2024, following PRISMA guidelines. Eligible studies used dexmedetomidine with other sedatives for ESD. We analyzed outcomes such as en-bloc and complete resection rates, sedation duration, and adverse events, using RevMan for meta-analysis with a random-effects model.
The initial search retrieved 216 studies and after screening, eight studies were included in the final analysis. Dexmedetomidine showed no significant difference in en-bloc or complete resection rates compared to controls. Sedation and procedure times were similar between the two groups as well. Dexmedetomidine significantly reduced restlessness (OR 0.15, 95% CI:0.07 to 0.29) and increased bradycardia (OR 7.15, 95% CI 3.17 to 16.11) compared to controls. Upon subgroup analysis, Dexmedetomidine plus Propofol, and Dexmedetomidine plus Midazolam, revealed the same findings regarding restlessness and bradycardia compared to controls which confirmed the adjunctive effects of Dexmedetomidine.
Dexmedetomidine as an adjunctive sedative appears safe and effective in ESD, reducing restlessness without significant adverse events. The risk of bradycardia is increased, which may be reflective of reduced physiological stress. Future studies should explore optimal dosing and compare Dexmedetomidine with other sedatives in diverse populations.
内镜黏膜下剥离术（ESD）是一种用于切除胃肠道发育异常病变的技术，但存在疼痛和穿孔等风险。右美托咪定是一种α2受体激动剂，作为ESD期间的辅助镇静剂，通过提供抗焦虑和镇痛作用可能带来潜在益处。本系统评价和荟萃分析评估了其疗效和安全性。
我们按照PRISMA指南，检索了截至2024年4月21日的Embase、Medline/PubMed、Scopus和Web of Science等数据库。符合条件的研究使用右美托咪定与其他镇静剂进行ESD。我们分析了整块切除率和完整切除率、镇静持续时间和不良事件等结果，使用RevMan进行随机效应模型的荟萃分析。
初步检索获得216项研究，经筛选后，最终分析纳入8项研究。与对照组相比，右美托咪定在整块切除率或完整切除率方面无显著差异。两组的镇静时间和手术时间也相似。与对照组相比，右美托咪定显著降低了躁动（比值比0.15，95%置信区间：0.07至0.29）并增加了心动过缓（比值比7.15，95%置信区间3.17至16.11）。亚组分析显示，与对照组相比，右美托咪定联合丙泊酚以及右美托咪定联合咪达唑仑在躁动和心动过缓方面得出了相同的结果，这证实了右美托咪定的辅助作用。
右美托咪定作为辅助镇静剂在ESD中似乎安全有效，可减少躁动且无明显不良事件。心动过缓风险增加，这可能反映了生理应激的降低。未来的研究应探索最佳剂量，并在不同人群中将右美托咪定与其他镇静剂进行比较。
