Original Article
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Clinical Outcomes and Adverse Events of Gastric Endoscopic Submucosal Dissection of the Mid to Upper Stomach under General Anesthesia and Monitored Anesthetic Care
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Jong-In Chang, Tae Jun Kim, Na Young Hwang, Insuk Sohn, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J Kim
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Clin Endosc 2022;55(1):77-85. Published online July 5, 2021
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DOI: https://doi.org/10.5946/ce.2021.002
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Abstract
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Supplementary Material
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- Background
/Aims: Endoscopic submucosal dissection (ESD) of gastric tumors in the mid-to-upper stomach is a technically challenging procedure. This study compared the therapeutic outcomes and adverse events of ESD of tumors in the mid-to-upper stomach performed under general anesthesia (GA) or monitored anesthesia care (MAC).
Methods
Between 2012 and 2018, 674 patients underwent ESD for gastric tumors in the midbody, high body, fundus, or cardia (100 patients received GA; 574 received MAC). The outcomes of the propensity score (PS)-matched (1:1) patients receiving either GA or MAC were analyzed.
Results
The PS matching identified 94 patients who received GA and 94 patients who received MAC. Both groups showed high rates of en bloc resection (GA, 95.7%; MAC, 97.9%; p=0.68) and complete resection (GA, 81.9%; MAC, 84.0%; p=0.14). There were no significant differences between the rates of adverse events (GA, 16.0%; MAC, 8.5%; p=0.18) in the anesthetic groups. Logistic regression analysis indicated that the method of anesthesia did not affect the rates of complete resection or adverse events.
Conclusions
ESD of tumors in the mid-to-upper stomach at our high-volume center had good outcomes, regardless of the method of anesthesia. Our results demonstrate no differences between the efficacies and safety of ESD performed under MAC and GA.
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Citations
Citations to this article as recorded by

- Effect of sufentanil combined with propofol or dexmedetomidine on perioperative oxidative stress in patients undergoing endoscopic submucosal dissection: A randomized controlled study
Yun Mao, Zhi-Hao Tang, Hui-Lan Chen, Xiao-Juan Zheng
World Chinese Journal of Digestology.2025; 33(6): 466. CrossRef - Efficacy, safety, and impact on procedural outcomes of local anesthesia in endoscopic submucosal dissection: a systematic review and meta-analysis
Hazem Abosheaishaa, Abdelmalek Abdelghany, Abdallfatah Abdallfatah, Doha Mohamed, Ammar Ayman Bahbah, Islam Mohamed, Khaled Elfert, Ahmed E. Salem, Azizullah Beran, Ahmad Madkour, Mohammad Al-Haddad
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Seung Hyun Kim
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Choy-May Leung, Rex Wan-Hin Hui
Anaesthesiology Intensive Therapy.2023; 55(1): 9. CrossRef - Is General Anesthesia Needed in Endoscopic Submucosal Dissection for Lesions Located in the Mid to Upper Stomach?
Prasit Mahawongkajit, Jirawat Swangsri
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Journal of the Korean Medical Association.2022; 65(5): 284. CrossRef - Paneth Cell Carcinoma of the Stomach
Jun Wan Kim, Gwang Ha Kim, Kyung Bin Kim
The Korean Journal of Gastroenterology.2022; 80(1): 34. CrossRef - Comparing Different Anesthesia Methods on Anesthetic Effect and Postoperative Pain in Patients with Early Gastric Cancer during Endoscopic Submucosal Dissection
Jie Zhang, Yanlei Chen, Zhiwu Liu, Zhihao Pan, Jinghua Pan
Journal of Oncology.2022; 2022: 1. CrossRef
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Focused Review Series: Cutting Edge of Advanced Therapeutic Endoscopy
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Peroral Endoscopic Myotomy for Esophageal Motility Disorders
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Jun Young Kim, Yang Won Min
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Clin Endosc 2020;53(6):638-645. Published online November 20, 2020
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DOI: https://doi.org/10.5946/ce.2020.223
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Abstract
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- Peroral endoscopic myotomy (POEM) is one of the most clinically successful tunnel-based minimally invasive endoscopic treatments. The classic indications of POEM include achalasia of all types, including failed prior treatments, and expanded indications include the non-achalasia esophageal motility disorders, such as esophagogastric junction outflow obstruction, diffuse esophageal spasm, and jackhammer esophagus. For achalasia treatment, POEM has achieved a comparable surgical efficacy and a safety outcome and, therefore, has emerged as a first-line treatment. For non-achalasia esophageal motility disorders, POEM has also shown high clinical response rates. The complication rate of POEM for esophageal motility disorders is low and most complications are managed with conservative treatment. Currently, POEM is a representative procedure of natural orifice transluminal endoscopic surgery, which has shown a good clinical efficacy with low complication rates for esophageal motility disorders including achalasia. However, further studies are needed to treat non-achalasia motility disorder via POEM.
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Reviews
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Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer
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Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong Yeul Lee, Jeong-Sik Byeon, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Hoon Jai Chun
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Clin Endosc 2020;53(2):142-166. Published online March 30, 2020
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DOI: https://doi.org/10.5946/ce.2020.032
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Abstract
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- Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.
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Quality Indicators for Small Bowel Capsule Endoscopy
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Ki-Nam Shim, Seong Ran Jeon, Hyun Joo Jang, Jinsu Kim, Yun Jeong Lim, Kyeong Ok Kim, Hyun Joo Song, Hyun Seok Lee, Jae Jun Park, Ji Hyun Kim, Jaeyoung Chun, Soo Jung Park, Dong-Hoon Yang, Yang Won Min, Bora Keum, Bo-In Lee, Korean Gut Image Study Group
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Clin Endosc 2017;50(2):148-160. Published online March 30, 2017
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DOI: https://doi.org/10.5946/ce.2017.030
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Abstract
PDF
Supplementary Material
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ePub
- Capsule endoscopy (CE) enables evaluation of the entire mucosal surface of the small bowel (SB), which is one of the most important steps for evaluating obscure gastrointestinal bleeding. Although the diagnostic yield of SB CE depends on many clinical factors, there are no reports on quality indicators. Thus, the Korean Gut Image Study Group (KGISG) publishes an article titled, “Quality Indicators for Small Bowel Capsule Endoscopy” under approval from the Korean Society of Gastrointestinal Endoscopy (KSGE). Herein, we initially identified process quality indicators, while the structural and outcome indicators are reserved until sufficient clinical data are accumulated. We believe that outcomes of SB CE can be improved by trying to meet our proposed quality indicators.
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Citations
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Xin Long He, Hui Min Chen, Han Bing Xue
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Tiago Ribeiro, Miguel José Mascarenhas Saraiva, João Afonso, Pedro Cardoso, Francisco Mendes, Miguel Martins, Ana Patrícia Andrade, Hélder Cardoso, Miguel Mascarenhas Saraiva, João Ferreira, Guilherme Macedo
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Lilli L. Zwinger, Britta Siegmund, Andrea Stroux, Andreas Adler, Winfried Veltzke-Schlieker, Robert Wentrup, Christian Jürgensen, Bertram Wiedenmann, Felix Wiedbrauck, Stephan Hollerbach, Thomas Liceni, Christian Bojarski
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Hyun Seok Lee, Yun Jeong Lim, Kyeong Ok Kim, Hyun Joo Jang, Jaeyoung Chun, Seong Ran Jeon, Yunho Jung, Ji Hyun Kim, Jae Jun Park, Sun-Jin Boo, Sun Hyung Kang, Seung-Joo Nam, Yoo Jin Lee
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Xiaohuan Li, Yongxian Gui, Feifei Shen, Chun Ling Zhao, Yi Yang, Wenliang Han
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Focused Review Series: Current Issues and Future Directions of Small Bowel Endoscopic Evaluation
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The Role of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding
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Yang Won Min, Dong Kyung Chang
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Clin Endosc 2016;49(1):16-20. Published online January 28, 2016
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DOI: https://doi.org/10.5946/ce.2016.49.1.16
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Abstract
PDF
PubReader
ePub
- Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases and is often caused by small bowel lesions. Capsule endoscopy (CE), which allows non-invasive visualization of the small bowel mucosa, has revolutionized the evaluation of OGIB. CE is preferred by both patients and physicians mainly because of its non-invasiveness, and is widely used as the first-line diagnostic modality for OGIB. The diagnostic yield of CE in OGIB has been reported to be in the range of 32% to 83%. Although no direct comparison has been made, a meta-analysis showed similar diagnostic yields between CE and double-balloon enteroscopy (DBE) for OGIB. However, CE could enhance the yield of subsequent DBE and serve as a guide for optimizing the insertion route for DBE. Even after negative CE, selected patients could benefit from second-look CE for OGIB. In terms of outcomes, a favorable clinical impact after CE has been reported in several studies. However, observations indicate that CE might not influence clinical outcomes directly, but rather play a role in selecting patients with OGIB who are likely to benefit from subsequent evaluation and intervention.
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Citations
Citations to this article as recorded by

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Chloé Leandri, Benoit Bordacahar, Sophie Ribiere, Ammar Oudjit, Marie-Anne Guillaumot, Bertrand Brieau, Frédéric Prat, Vered Abitbol, Stanislas Chaussade, Romain Coriat
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