Digestive Diseases and Sciences

, Volume 58, Issue 2, pp 540–546 | Cite as

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

  • Chan Hyuk Park
  • Hyunzu Kim
  • Young Ae Kang
  • In Rae Cho
  • Bun Kim
  • Su Jin Heo
  • Suji Shin
  • Hyuk Lee
  • Jun Chul Park
  • Sung Kwan Shin
  • Yong Chan Lee
  • Sang Kil LeeEmail author
Original Article



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.


To analyze the clinical features of pneumonia after ESD and to suggest a treatment plan.


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.


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.


Deep sedation under continuous propofol infusion with opioid injection during ESD may be a risk factor for pneumonia.


Endoscopic submucosal dissection Propofol Sedation Aspiration pneumonia 


Conflicts of interest



  1. 1.
    Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Lochhead P, El-Omar EM. Gastric cancer. Br Med Bull. 2008;85:87–100.PubMedCrossRefGoogle Scholar
  3. 3.
    Shimizu S, Tada M, Kawai K. Early gastric cancer: its surveillance and natural course. Endoscopy. 1995;27:27–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Anonymous. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–123.CrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 6.
    Makuuchi H, Kise Y, Shimada H, et al. Endoscopic mucosal resection for early gastric cancer. Semin Surg Oncol. 1999;17:108–116.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 9.
    Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006;41:929–942.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 12.
    DeLegge MH. Aspiration pneumonia: incidence, mortality, and at-risk populations. JPEN J Parenter Enteral Nutr. 2002;26:S19–S24. discussion S24–S15.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 14.
    Anonymous. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–112.CrossRefGoogle Scholar
  15. 15.
    Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–140.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 23.
    Tagaito Y, Isono S, Nishino T. Upper airway reflexes during a combination of propofol and fentanyl anesthesia. Anesthesiology. 1998;88:1459–1466.PubMedCrossRefGoogle Scholar
  24. 24.
    Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344:665–671.PubMedCrossRefGoogle Scholar
  25. 25.
    Tierney WM, Adler DG, Conway JD, et al. Overtube use in gastrointestinal endoscopy. Gastrointest Endosc. 2009;70:828–834.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Chan Hyuk Park
    • 1
  • Hyunzu Kim
    • 2
  • Young Ae Kang
    • 3
  • In Rae Cho
    • 1
  • Bun Kim
    • 1
  • Su Jin Heo
    • 1
  • Suji Shin
    • 1
  • Hyuk Lee
    • 1
  • Jun Chul Park
    • 1
  • Sung Kwan Shin
    • 1
  • Yong Chan Lee
    • 1
  • Sang Kil Lee
    • 1
    Email author
  1. 1.Institute of Gastroenterology, Department of Internal MedicineYonsei University College of MedicineSeodaemun-gu, SeoulRepublic of Korea
  2. 2.Department of AnesthesiologyYonsei University College of MedicineSeodaemun-gu, SeoulRepublic of Korea
  3. 3.Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineYonsei University College of MedicineSeodaemun-gu, SeoulRepublic of Korea

Personalised recommendations