Comparison of general anesthesia and conscious sedation in procedure-related complications during esophageal endoscopic submucosal dissection

Abstract

Background

Endoscopic submucosal dissection (ESD) has a favorable outcome, compared to esophagectomy, for early esophageal neoplasia. Recent studies used general anesthesia for esophageal ESD to minimize complications due to insufficient sedation and patient movement. We aimed to evaluate the safety of general anesthesia in comparison with conscious sedation provided by anesthesiologists for esophageal ESD.

Methods

We retrospectively reviewed the electronic medical records of 158 patients who underwent esophageal ESD under general anesthesia or conscious sedation provided by anesthesiologists. We evaluated the incidence of procedure-related complications, including perforation, post-ESD bleeding, cardiopulmonary adverse events (arrhythmia, hypotension, and hypoxemia), procedure failure, stricture, and new lung consolidation after ESD. Cases of frank perforation, post-ESD bleeding requiring a vigorous diagnostic approach, and cardiopulmonary adverse events were regarded as acute complications of ESD.

Results

Acute complications occurred only in the conscious sedation group (8/83 [9.6%] vs. 0/75 [0.0%]; p value = 0.007). The numbers of patients with frank perforation, post-ESD bleeding, and cardiopulmonary adverse events were four, one, and three, respectively. Moreover, new lung consolidation after ESD developed only in the conscious sedation group (7/83 [8.4%] vs. 0/75 [0.0%]; p value = 0.014). ESD failed in four patients in the conscious sedation group. The incidences of stricture that required stent insertion and hospital stay after ESD were comparable between the two groups.

Conclusion

General anesthesia is associated with a lower incidence of acute procedure-related complications in esophageal ESD compared to conscious sedation provided by anesthesiologists. Therefore, we recommend general anesthesia as a safer option for esophageal ESD.

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Authors

Contributions

SHK designed the research, collected and analyzed the data, and wrote the manuscript; YSC, SKL, and HO collected and analyzed the data, and wrote the manuscript; SHC designed the research, collected and analyzed the data, and wrote the manuscript; all authors reviewed the manuscript prior to its submission, and read and approved the final manuscript.

Corresponding author

Correspondence to Seung Ho Choi.

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Disclosures

Drs. Seung Hyun Kim, Yong Seon Choi, Sang Kil Lee, Hanseul Oh, and Seung Ho Choi have no conflicts of interest or financial ties to disclose.

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The study protocol was approved by the Institutional Review Board of the Yonsei University Health System, Seoul, South Korea.

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Kim, S.H., Choi, Y.S., Lee, S.K. et al. Comparison of general anesthesia and conscious sedation in procedure-related complications during esophageal endoscopic submucosal dissection. Surg Endosc 34, 3560–3566 (2020). https://doi.org/10.1007/s00464-020-07663-9

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Keywords

  • Esophageal endoscopic submucosal resection
  • Complication
  • General anesthesia
  • Conscious sedation