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Clinicopathological characteristics of patients with pain after endoscopic submucosal dissection for gastric epithelial neoplasm

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Abstract

Background

Endoscopic submucosal dissection (ESD) is widely used for large superficial gastrointestinal tumors. Epigastric pain is a frequent complication of ESD. However, little is known about its incidence and associated factors. This study evaluated pain incidence and characteristics of patients with pain after gastric ESD.

Methods

We retrospectively analyzed a prospectively collected registry of clinical, endoscopic, and pathologic results of patients who underwent ESD for gastric adenoma or cancer from January 2010 to December 2015. A Visual Analogue Scale (VAS) was used to assess pain immediately after, and 2, 12, and 24 h after ESD. The primary outcome was the use of painkillers (VAS score > 4). Analyzed data included age, sex, pathology, specimen and tumor size, procedure time, and tumor location.

Results

Of 1226 patients, 461 (36.4%) needed a painkiller at least once after ESD (pain group). Compared with the no pain group, the pain group had more females, less alcohol consumption, larger tumor and specimen size, and more antral lesions. In multivariate analysis, female sex (OR 1.559, 95% CI 1.217–1.996, p < 0.001), antral tumor location (OR 1.780, 95% CI 1.398–2.265, p < 0.001), and procedure time over 30 min (OR 1.443, 95% CI 1.130–1.842, p = 0.003) were predictive factors for pain.

Conclusion

This study showed that a considerable number of patients needed one or more painkiller doses after gastric ESD. The factors affecting pain included sex, procedure time, and lesion location. Endoscopists should use preemptive or aggressive pain management in high-risk patients after ESD.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemoongu, Seoul, 02447, Republic of Korea

    Jung-Wook Kim, Jae-Young Jang, Jae-Jun Shim & Young Woon Chang

  2. Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea

    Yoo Min Park

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  1. Jung-Wook Kim
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  2. Jae-Young Jang
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Correspondence to Jae-Young Jang.

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Disclosures

Jung-Wook Kim, Jae-Young Jang, Yoo Min Park, Jae-Jun Shim, and Young Woon Chang have no conflicts of interest or financial ties to disclose

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Kim, JW., Jang, JY., Park, Y.M. et al. Clinicopathological characteristics of patients with pain after endoscopic submucosal dissection for gastric epithelial neoplasm. Surg Endosc 33, 794–801 (2019). https://doi.org/10.1007/s00464-018-6345-3

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  • DOI: https://doi.org/10.1007/s00464-018-6345-3

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