Comparison of the Efficacy and Safety of General Anesthesia and Sedation Management for Esophageal Endoscopic Submucosal Dissection: A Retrospective Study.

INTRODUCTION

General anesthesia (GA) for esophageal endoscopic submucosal dissection (ESD) is expected to reduce surgical complications and shorten surgical time, but definitive conclusions have not yet been reached. We retrospectively compared the efficacy and safety of GA with conventional sedation management.

METHODS

The study analyzed 224 consecutive cases of esophageal ESD performed at a single institution. The primary outcome was procedure time, and secondary outcomes were duration of endoscopy room stay, incidence of complications (aspiration, perforation, bleeding), and incidence of intraoperative vital sign deterioration (hypotension, bradycardia, hypoxia).

RESULTS

The study included 76 patients who underwent GA and 148 patients who underwent sedation (Sed). There was no difference in the median procedure time between the GA group, 67.5 (interquartile range [IQR], 48.8-97.8), and the Sed group, 70 (IQR, 46.0-95.25) minutes (p = 0.993). The median duration of endoscopy room stay was longer in the GA group, 121.5 (102.3-153), than in the Sed group, 90 (69-124) minutes (p = 0.000). There were no significant differences in complications, including aspiration (0/76 vs. 2/148, p = 0.550), perforation (1/76 vs. 3/148, p = 1.000), and bleeding (0/76 vs. 1/148, p = 1.000). Intraoperative vital signs showed a higher incidence of hypotension (70/76 vs. 15/148, p = 0.000) and bradycardia (34/76 vs. 10/148, p = 0.000) in the GA group.

CONCLUSION

There was no difference in procedure time between GA and sedation management for esophageal ESD. Although complications tended to be fewer, hypotension and bradycardia were frequent with GA management. Further investigation is needed to evaluate efficacy and safety.