Efficacy of Propofol Sedation for Endoscopic Submucosal Dissection (ESD): Assessment with Prospective Data Collection

Abstract

Objective The indications for endoscopic treatment in early stage cancer of the digestive tract are expanding with the emergence and technical development of endoscopic submucosal dissection (ESD). ESD requires longer term stable sedation than conventional endoscopic procedures due to the necessity of meticulous control of the devices during the procedure. Propofol has a very short half-life and can be administered continuously, which is advantageous for long-term sedation. Propofol, thus, is likely to be useful for sedation during ESD. Methods Fifty consecutive patients who underwent ESD for early gastric cancer with propofol sedation (Group P) and those with midazolam sedation (Group M) were included in this study. Cardiorespiratory suppression rate and the condition of arousal were compared between the groups. A questionnaire survey on the satisfaction of endoscopists, anesthesiologists, endoscopy nurses, and ward nurses with the use of propofol was also carried out. Results Respiratory suppression was observed in 50% in Group M and in 20% in Group P (p<0.05). Hypotension was seen in 14% and 36% in Groups M and P, respectively (p<0.05). No sedation-related complications were encountered in either of the groups. Arousal rates 1 hour and 3 hours after the procedure were 23% and 60% in group M and 86% and 100% in Group P (p<0.05). As for the questionnaire survey, most respondents, in particular the ward nurses, supported the use of propofol. Conclusion Our data suggest that propofol is safe and useful during ESD as compared with midazolam.

Association between CT-Diagnosed Pneumonia and Endoscopic Submucosal Dissection of Gastric Neoplasms

“…Propofol is a short-acting sedative, with a plasma half-life of only 1-4 min, which is considerably lesser than that of a benzodiazepine. Kiriyama et al [1] and Yamagata et al [2] reported that patients who underwent ESD with propofol sedation had a quicker recovery profile than those who underwent ESD with midazolam sedation. Propofol is considered a useful drug because the quick recovery from its sedation may decrease the incidence of aspiration pneumonia.…”

“…Until now, the usefulness of various sedation methods for ESD has been reported [1,2,3]; however, major critical complications after ESD such as perforation and bleeding have also been reported; perforation and postoperative bleeding occurred in 2-4% and 4-6% of cases, respectively [4,5,6,7,8]. Furthermore, aspiration pneumonia, venous thrombosis and phlegmonous gastritis have been reported as rare complications of ESD [9,10].…”

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

“…An analgesic (pentazocine, 7.5-15 mg) was given intravenously at the beginning of sedation and further injection was performed depending on the patient's condition. When the combination of propofol and pentazocine could not achieve or maintain an adequate level of sedation, droperidol was added [15] .…”

Safety and Efficacy of Deep Sedation with Propofol Alone or Combined with Midazolam Administrated by Nonanesthesiologist for Gastric Endoscopic Submucosal Dissection

“…12,13 However, this agent occasionally decreases systemic vascular resistance, cardiac contractility, and ultimately cardiac output without a concomitant change in heart rate, and respiratory depression can also occur. 5,14,15 Recently, several studies have revealed most adverse events associated with propofol sedation were mild and often transient during advanced interventional endoscopic procedure. 12,[16][17][18] A randomized study in Japan, which compared continuous propofol infusion with intermittent midazolam injection during ESD for EGC, found that propofol is a safe and effective sedative agent and that patients treated with propofol had a quicker recovery than those who were treated with midazolam.…”

“…Recently, a number of studies for propofol sedation during ESD by nonanesthesiologist have proven that propofol sedation has similar safety profile compared to conventional sedation with midazolam. 3,5,6 In these studies, propofol was administrated in bolus or by continuous infusion, and target sedation level was mostly moderate sedation. However, intermittent bolus injection of propofol may be theoretically associated with fluctuation of plasma concentration.…”