title: Reasonable decision of anesthesia methods in patients who underwent endoscopic submucosal dissection for superficial esophageal carcinoma: A retrospective analysis in a single Japanese institution.
abstract: OBJECTIVE
  Despite being a valuable therapeutic option, it has not yet been reported whether endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma should be performed under general or non-general anesthesia (sedation).
  
  
  METHODS
  The clinicopathological factors (age, sex, histology, tumor size, tumor location, tumor macroscopic morphology, and adverse events) of 110 superficial esophageal carcinoma lesions (98 patients) treated by ESD at a single Japanese institution from January 2007 to December 2013 were retrospectively reviewed using medical records.
  
  
  RESULTS
  Among 110 lesions, 94 lesions were resected under general anesthesia, and 16 lesions were resected under non-general anesthesia by an experienced endoscopist. Although the number of complications was 12 in the group of general anesthesia and 1 in sedated patients, no significant differences between both groups were found in the incidence of adverse events (total adverse events: 12.2% versus 1.02%, p=0.456; mediastinal emphysema: 11.2% versus 1.02%, p=0.518; pulmonary atelectasis: 1.02% versus 0%, p=0.679). All of the events could be managed conservatively.
  
  
  CONCLUSIONS
  For ordered management of accidental events during esophageal ESD, general anesthesia might be a crucial option for a better clinical outcome even when administered by non-experienced operators.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. takujigotoda@yahoo.co.jp.
authors.forename: Naoko
authors.initials: N
authors.lastname: Yagi Kuwata
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.forename: Sho
authors.initials: S
authors.lastname: Suzuki
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Mukai
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D000066491:Clinical Decision-Making; D016292:Procedural Sedation / Q000379:methods*; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome