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

Abstract

The aim of this study was to assess the perioperative invasiveness of endoscopic submucosal dissection for colorectal cancer quantitatively by using energy metabolism. In fifty-three patients who underwent endoscopic submucosal dissection for colorectal cancer, 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 19.7 ± 2.5 kcal/kg/day and 0.96 ± 0.12 on the day of endoscopic submucosal dissection, whereas one day after the endoscopic submucosal dissection they increased to 21.0 ± 2.9 kcal/kg/day and 1.00 ± 0.13 (p<0.001 and p<0.05, respectively). The stress factor on the postoperative day 1 was computed as 1.06. The increase was lower comparing with that experienced for surgery, suggesting that the perioperative invasiveness of colorectal endoscopic submucosal dissection is lower in comparison to that during surgery. Furthermore, in spite of technical difficulty, stress factor of colorectal endoscopic submucosal dissection was approximately equal to that of gastric endoscopic submucosal dissection. (The study of the resting energy metabolism and stress factor using an indirect calorimeter in the perioperative period of endoscopic operation: UMIN000027135)

Assessment of physical stress during the perioperative period of endoscopic submucosal dissection

“…According to Long’s method[ 28 ], the total energy expenditure is defined as the product of BEE, SF, and the activity factor, and it is theoretically the same as the REE measured at rest. Since the activity factor on the day of ESD is the same as that on postoperative day (POD) 1, the SF on POD 1 can be calculated by setting SF on the day to be 1.0[ 33 , 34 ]. From the above, SF is a marker indicating the degree of hypermetabolic state[ 33 , 34 ].…”

“…Since the activity factor on the day of ESD is the same as that on postoperative day (POD) 1, the SF on POD 1 can be calculated by setting SF on the day to be 1.0[ 33 , 34 ]. From the above, SF is a marker indicating the degree of hypermetabolic state[ 33 , 34 ]. The values of SFs are recognized as 1.1 for low invasiveness, 1.2 for medium invasiveness, and 1.8 for high invasiveness[ 28 ], and these values are used as indicators to determine perioperative energy management.…”

“…As shown in Table 1 , the changes in the perioperative REE and SFs differed between gastric and colorectal ESD[ 33 , 34 ]. Regarding gastric ESD, the REE and REE/BEE increased significantly from the day of gastric ESD to POD 1.…”

“…However, REE/BEE was significantly higher on POD 1 than on the day of ESD. The SF for colorectal ESD on POD 1 was calculated as 1.06[ 34 ].…”

Influence of gastric endoscopic submucosal dissection on serum opsonic activity measured by chemiluminescence

“…Our previous studies, which measured the change in energy metabolism using an indirect calorimeter and Long’s method, revealed that the degree of invasion during the perioperative period of ESD was lower than that during surgery. ( 6 , 7 ) Another study also showed that salivary amylase activity was increased by the physical stress associated with gastric ESD, including pain. ( 8 ) Previously, the invasiveness of surgery had been evaluated by measuring the levels of catecholamine, cortisol, adrenocorticotropic hormone, blood sugar, blood insulin or interleukin-6.…”