title: Risk factors and prognosis of pulmonary complications after endoscopic submucosal dissection for gastric neoplasia.
abstract: BACKGROUND
  Hospital-acquired pneumonia after an endoscopic submucosal dissection (ESD) can prolong the patient's stay in the hospital, leading to greater healthcare costs. However, little is known of the characteristics and risk factors associated with this complication.
  
  
  OBJECTIVE
  To analyze the clinical features of pneumonia after ESD and to suggest a treatment plan.
  
  
  METHODS
  This was a retrospective study in which the cases of 1,661 consecutive patients who underwent ESD for 1,725 lesions between January 2008 and June 2011 were reviewed.
  
  
  RESULTS
  Of the 1,661 patients who underwent ESD during the study period, 38 were subsequently diagnosed with pneumonia, and an additional 18 patients exhibited lung consolidation, based on chest radiography, without respiratory signs or symptoms. The remaining 1,605 patients showed neither lung consolidation on chest radiography nor respiratory signs/symptoms. Continuous propofol infusion with intermittent or continuous administration of an opioid [odds ratio (OR) 4.498, 95 % confidence interval (CI) 2.267-8.923], a procedure time of >2 h (OR 2.900, 95 % CI 1.307-6.439), male gender (OR 2.835, 95 % CI 1.164-6.909), and age >75 years (OR 2.765, 95 % CI 1.224-6.249) were independent risk factors for pneumonia after ESD. In patients with only lung consolidation (without respiratory signs and symptoms), the length of hospital stay and prognosis were not affected by antibiotics use.
  
  
  CONCLUSIONS
  Deep sedation under continuous propofol infusion with opioid injection during ESD may be a risk factor for pneumonia.
authors.affiliation: Institute of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. chan100@yuhs.ac
authors.forename: Chan Hyuk
authors.initials: CH
authors.lastname: Park
authors.forename: Hyunzu
authors.initials: H
authors.lastname: Kim
authors.forename: Young Ae
authors.initials: YA
authors.lastname: Kang
authors.forename: In Rae
authors.initials: IR
authors.lastname: Cho
authors.forename: Bun
authors.initials: B
authors.lastname: Kim
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Heo
authors.forename: Suji
authors.initials: S
authors.lastname: Shin
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Park
authors.forename: Sung Kwan
authors.initials: SK
authors.lastname: Shin
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015897:Comorbidity; D003428:Cross Infection / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D004210:Dissection / Q000009:adverse effects; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents