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Risk Factors and Prognosis of Pulmonary Complications After Endoscopic Submucosal Dissection for Gastric Neoplasia

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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.

Aims

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.

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References

  1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  PubMed  Google Scholar 

  2. Lochhead P, El-Omar EM. Gastric cancer. Br Med Bull. 2008;85:87–100.

    Article  PubMed  Google Scholar 

  3. Shimizu S, Tada M, Kawai K. Early gastric cancer: its surveillance and natural course. Endoscopy. 1995;27:27–31.

    Article  PubMed  CAS  Google Scholar 

  4. Anonymous. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–123.

    Article  Google Scholar 

  5. Kojima T, Parra-Blanco A, Takahashi H, et al. Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc. 1998;48:550–554. discussion 554–555.

    Article  PubMed  CAS  Google Scholar 

  6. Makuuchi H, Kise Y, Shimada H, et al. Endoscopic mucosal resection for early gastric cancer. Semin Surg Oncol. 1999;17:108–116.

    Article  PubMed  CAS  Google Scholar 

  7. Coda S, Lee SY, Gotoda T. Endoscopic mucosal resection and endoscopic submucosal dissection as treatments for early gastrointestinal cancers in Western countries. Gut Liver. 2007;1:12–21.

    Article  PubMed  Google Scholar 

  8. Akasaka T, Nishida T, Tsutsui S, et al. Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by Osaka University ESD study group. Dig Endosc. 2011;23:73–77.

    Article  PubMed  Google Scholar 

  9. Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006;41:929–942.

    Article  PubMed  Google Scholar 

  10. Isomoto H, Ohnita K, Yamaguchi N, et al. Clinical outcomes of endoscopic submucosal dissection in elderly patients with early gastric cancer. Eur J Gastroenterol Hepatol. 2010;22:311–317.

    Article  PubMed  Google Scholar 

  11. Lee IL, Wu CS, Tung SY, et al. Endoscopic submucosal dissection for early gastric cancers: experience from a new endoscopic center in Taiwan. J Clin Gastroenterol. 2008;42:42–47.

    Article  PubMed  Google Scholar 

  12. DeLegge MH. Aspiration pneumonia: incidence, mortality, and at-risk populations. JPEN J Parenter Enteral Nutr. 2002;26:S19–S24. discussion S24–S15.

    Article  PubMed  Google Scholar 

  13. Kozlow JH, Berenholtz SM, Garrett E, et al. Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999–2000. Crit Care Med. 2003;31:1930–1937.

    Article  PubMed  Google Scholar 

  14. Anonymous. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–112.

    Article  Google Scholar 

  15. Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–140.

    Article  PubMed  CAS  Google Scholar 

  16. Cote GA, Hovis RM, Ansstas MA, et al. Incidence of sedation-related complications with propofol use during advanced endoscopic procedures. Clin Gastroenterol Hepatol. 2010;8:137–142.

    Article  PubMed  Google Scholar 

  17. Nayar DS, Guthrie WG, Goodman A, et al. Comparison of propofol deep sedation versus moderate sedation during endosonography. Dig Dis Sci. 2010;55:2537–2544.

    Article  PubMed  CAS  Google Scholar 

  18. van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, et al. Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc. 2011;12:344–354.

    Article  PubMed  Google Scholar 

  19. Knol W, van Marum RJ, Jansen PA, et al. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc. 2008;56:661–666.

    Article  PubMed  Google Scholar 

  20. Skull SA, Andrews RM, Byrnes GB, et al. Hospitalized community-acquired pneumonia in the elderly: an Australian case-cohort study. Epidemiol Infect. 2009;137:194–202.

    Article  PubMed  CAS  Google Scholar 

  21. Bleach NR. The gag reflex and aspiration: a retrospective analysis of 120 patients assessed by videofluoroscopy. Clin Otolaryngol Allied Sci. 1993;18:303–307.

    Article  PubMed  CAS  Google Scholar 

  22. Yoshida H, Ayuse T, Ishizaka S, et al. Management of exaggerated gag reflex using intravenous sedation in prosthodontic treatment. Tohoku J Exp Med. 2007;212:373–378.

    Article  PubMed  Google Scholar 

  23. Tagaito Y, Isono S, Nishino T. Upper airway reflexes during a combination of propofol and fentanyl anesthesia. Anesthesiology. 1998;88:1459–1466.

    Article  PubMed  CAS  Google Scholar 

  24. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344:665–671.

    Article  PubMed  CAS  Google Scholar 

  25. Tierney WM, Adler DG, Conway JD, et al. Overtube use in gastrointestinal endoscopy. Gastrointest Endosc. 2009;70:828–834.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Chan Hyuk Park, In Rae Cho, Bun Kim, Su Jin Heo, Suji Shin, Hyuk Lee, Jun Chul Park, Sung Kwan Shin, Yong Chan Lee & Sang Kil Lee

  2. Department of Anesthesiology, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Hyunzu Kim

  3. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Young Ae Kang

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  1. Chan Hyuk Park
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  2. Hyunzu Kim
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  3. Young Ae Kang
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  4. In Rae Cho
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  5. Bun Kim
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  7. Suji Shin
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  8. Hyuk Lee
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  9. Jun Chul Park
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  12. Sang Kil Lee
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Correspondence to Sang Kil Lee.

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Park, C.H., Kim, H., Kang, Y.A. et al. Risk Factors and Prognosis of Pulmonary Complications After Endoscopic Submucosal Dissection for Gastric Neoplasia. Dig Dis Sci 58, 540–546 (2013). https://doi.org/10.1007/s10620-012-2376-0

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  • DOI: https://doi.org/10.1007/s10620-012-2376-0

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