title: Sedation methods can determine performance of endoscopic submucosal dissection in patients with gastric neoplasia.
abstract: BACKGROUND
  Although proper sedation is mandatory for endoscopic procedures such as endoscopic submucosal dissection (ESD), there is no research investigating the effects of sedation on ESD performance and complications. We aimed to evaluate the relationship among sedation methods, clinical outcomes, and complications after ESD for gastric neoplasia.
  
  
  METHODS
  We retrospectively reviewed clinical data of 1,367 patients with 1,485 lesions who had undergone ESD for gastric adenoma or early gastric cancer at our tertiary teaching hospital in Seoul, Korea, between January 2008 and May 2011. Of these, 1,035 lesions in 958 patients were included in the intermittent midazolam/propofol injection by endoscopists (IMIE) group, and 450 lesions in 409 patients were included in the continuous propofol infusion with opioid administration by anesthesiologists (CPIA) group.
  
  
  RESULTS
  En bloc resection and complete resection rates were higher in the CPIA group than in the IMIE group (CPIA vs. IMIE; en bloc resection, 99.8 and 95.0 %, P < 0.001; complete resection, 94.2 and 88.3 %, P < 0.001). Duration of procedure was shorter in the CPIA group than in the IMIE group (CPIA vs. IMIE; 48.2 ± 32.5 and 57.6 ± 41.3 min, P < 0.001). In multivariate analysis, sedation method was an independent factor associated with en bloc resection and complete resection. Additionally, sedation with CPIA was not a risk factor for bleeding (P = 0.403) or perforation (P = 0.474); however, aspiration pneumonia developed more frequently in patients sedated with CPIA (CPIA vs. IMIE, 4.4 and 1.5 %, P = 0.002).
  
  
  CONCLUSIONS
  Sedation with CPIA can improve ESD performance.
authors: Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Republic of Korea.
authors: Chan Hyuk
authors: CH
authors: Park
authors: Jae Hoon
authors: JH
authors: Min
authors: Young-Chul
authors: YC
authors: Yoo
authors: Hyunzu
authors: H
authors: Kim
authors: Dong Hoo
authors: DH
authors: Joh
authors: Jung Hyun
authors: JH
authors: Jo
authors: Suji
authors: S
authors: Shin
authors: Hyuk
authors: H
authors: Lee
authors: Jun Chul
authors: JC
authors: Park
authors: Sung Kwan
authors: SK
authors: Shin
authors: Yong Chan
authors: YC
authors: Lee
authors: Sang Kil
authors: SK
authors: Lee
mesh_terms: D016292:Procedural Sedation / Q000379:methods*; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
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