Energy metabolism during the perioperative period of gastric endoscopic submucosal dissection

Abstract

The aim of this study was to investigate the change in the energy metabolism and invasiveness in the perioperative period of endoscopic submucosal dissection for early gastric cancer. Fifty-two consecutive patients were enrolled into the study between July 2013 and May 2014 and examined resting energy expenditure using an indirect calorimeter, body weight and basal energy expenditure using the Harris–Benedict equation before and after endoscopic submucosal dissection. Resting energy expenditure/body weight and resting energy expenditure/basal energy expenditure were 20.2 ± 3.0 kcal/kg/day and 0.96 ± 0.11 on the day of endoscopic submucosal dissection, whereas one day after the endoscopic submucosal dissection they were 21.7 ± 3.2 kcal/kg/day and 1.03 ± 0.14, showing significant increases (p<0.001, respectively). The stress factor on the postoperative day 1 was computed as 1.07. This increase was low in comparison to that experienced for surgery, suggesting that the degree of perioperative invasiveness in patients receiving endoscopic submucosal dissection is lower in comparison to that during surgery (The study of the resting energy metabolism and stress factor using an indirect calorimeter in the perioperative period of endoscopic operation: UMIN000027135).

Estimation of perioperative invasiveness of colorectal endoscopic submucosal dissection evaluated by energy metabolism

“…The physical invasiveness has been expressed by the acceleration of the energy metabolism. ( 6 – 13 , 24 , 25 ) It is evident from the significant increases of REE/BW and stress factor of this study that invasiveness in perioperative period of ESD for colorectal cancer enhances the energy metabolism.…”

“…Our previous study on gastric ESD showed that energy expenditure per kg of body weight and stress factor also increased during the ESD perioperative period. ( 13 ) The study indicated that the stress factor on gastric ESD postoperative day 1 was 1.07. ( 13 ) As described before, colorectal and gastric ESD are different in the perioperative management as well as technical difficulty.…”

“…Measurement of REE was performed in the same way as shown in our previous study. ( 13 ) In brief, REE was measured using indirect calorimeter METAVINE-N VMB-002N (VINE, Tokyo, Japan). METAVINE-N computes REE using the oxygen concentration and respiration rate in the breath; it does not use the carbon dioxide concentration.…”

“…Stress factors are the markers of hyper-metabolic status. ( 13 , 16 – 20 , 23 ) Since the preoperative and postoperative activity factors are the same in a state of rest, assuming the REE/BEE on the day of ESD to be 1, and the REE/BEE measured on the postoperative day 1 can be considered as the stress factor.…”

“…Our previous study indicated that both REE/BW and stress factor increased during the perioperative period of ESD for early gastric cancer while the increase was lower in comparison with those experienced for surgery. ( 13 )…”