Usefulness of dexmedetomidine for endoscopic submucosal dissection in colon
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ABSTRACT:
DISEASE(S): Colorectal Tumor
PROVIDER: 2637033 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:Background and aimsIntraoperative perforation is a major adverse event of endoscopic submucosal dissection (ESD). To avoid perforation, it is important for the endoscope to approach the portion to be resected carefully and to ensure that the knife can approach the submucosa at an angle parallel to the muscle layer. The multibending endoscope has 2 bends at its tip and may facilitate the ESD procedure. To the best of our knowledge, very few studies have reported the use of the multibending endoscope during gastric ESD. The aim of this study was, therefore, to introduce the usefulness of the multibending endoscope for gastric ESD.MethodsWe report 2 cases of early gastric cancer in which ESD was performed using a multibending endoscope.ResultsUnlike conventional single-bending endoscopes that have only 1 moveable part, the multibending endoscope allowed difficult areas to be approached more easily. Small adjustments could be made to the upward or downward angle of both the first and the second bending sections of the endoscope. This ensured that the knife would approach the submucosa at an angle parallel to the muscle layer. In patient 1, initially the conventional endoscope was used, but it became more difficult to approach the site, and paradoxic movement occurred. When the conventional endoscope was changed to the multibending endoscope, the ESD procedure became safer and more efficient. Another ESD using the multibending endoscope was performed successfully without any adverse events.ConclusionsThe use of a multibending endoscope for ESD will enable safer and faster treatment of patients.
| S-EPMC6895728 | biostudies-literature
Project description:Interventions: Endoscopic submucosal dissection is performed using sedation of dexmedetomidine.
Primary outcome(s): Two hours after the treatmentwas finished, patient’s quaestionaire about pain, nausea and satisfaction of the sedation is evaluated.
Study Design: Single arm Non-randomized
| 2635391 | ecrin-mdr-crc
Project description: Not available
| S-EPMC8276354 | biostudies-literature
Project description: Not available
| S-EPMC7426889 | biostudies-literature
Project description:To compare the efficacy and safety of sedation protocols for endoscopic submucosal dissection (ESD) between dexmedetomidine-remifentanil and propofol-remifentanil.Fifty-nine patients scheduled for ESD were randomly allocated into a dexmedetomidine-remifentanil (DR) group or a propofol-remifentanil (PR) group. To control patient anxiety, dexmedetomidine or propofol was infused to maintain a score of 4-5 on the Modified Observer's Assessment of Alertness/Sedation scale. Remifentanil was infused continuously at a rate of 6 ?g/kg per hour in both groups. The ease of advancing the scope into the throat, gastric motility grading, and satisfaction of the endoscopist and patient were assessed. Hemodynamic variables and hypoxemic events were compared to evaluate patient safety.Demographic data were comparable between the groups. The hemodynamic variables and pulse oximetry values were stable during the procedure in both groups despite a lower heart rate in the DR group. No oxygen desaturation events occurred in either group. Although advancing the scope into the throat was easier in the PR group ("very easy" 24.1% vs 56.7%, P = 0.010), gastric motility was more suppressed in the DR group ("no + mild" 96.6% vs 73.3%, P = 0.013). The endoscopists felt that the procedure was more favorable in the DR group ("very good + good" 100% vs 86.7%, P = 0.042), whereas patient satisfaction scores were comparable between the groups. En bloc resection was performed 100% of the time in both groups, and the complete resection rate was 94.4% in the DR group and 100% in the PR group (P = 0.477).The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, the endoscopists favored dexmedetomidine perhaps due to lower gastric motility.
| S-EPMC4375593 | biostudies-literature
Project description:Progress in the endoscopy technology field led to an increase in the diagnosis of early gastrointestinal (GI) superficial lesions and to an improvement of their treatment. Endoscopic submucosal dissection (ESD) has been developed in Japan with the aim of removing such lesions in one piece, in order to obtain a curative resection and to minimize the risk of local recurrence, and to preserve the native organ. ESD is widely used in Asia for the treatment of early upper and lower GI lesions and is currently gaining attention in Western countries too. However, ESD can be safely performed only by expert endoscopists and in specific clinical settings. Therefore, prior to decide whether ESD is feasible or not, the target lesion must be carefully assessed, in order to understand whether or not it is eligible for submucosal dissection. The aim of this paper is to review indications, limitations and technical aspects of upper GI ESD.
| S-EPMC6064797 | biostudies-literature
Project description:Conscious sedation for colorectal endoscopic submucosal dissection (ESD) has not been standardized, and there are no studies of sedation for colorectal ESD.We conducted a prospective double-blind randomized controlled trial to clarify the usefulness of DEX during colorectal ESD. In total 80 patients with colorectal ESD from April 2016 to May 2017 were assigned to the placebo group or the DEX group (40 cases each). The primary outcome was patient satisfaction (visual analogue scale: VAS). Secondary outcomes were evaluated for 13 factors, including patient pain level (VAS), endoscopist satisfaction (VAS), objective patient pain level viewed from the endoscopist's perspective (VAS), rate of patient response, rate of side effects, etc., from the patient's and endoscopist's perspectives.Patient satisfaction was 8.4 and 9.1 (P?=?0.018) in the placebo group and the DEX group, respectively. Secondary outcomes of patient pain level, endoscopist satisfaction, objective patient pain level from the endoscopist's perspective for the placebo and DEX groups were 1.2 and 0.4 (P?=?0.045), 8.2 and 9.3 (P?<?0.001), and 1.2 and 0.5 (P?=?0.002), respectively. All of these were significantly positive results (more comfortable and less pain) in the DEX group. The rate of a patient response was 100% in all cases. The side effects (hypoxia/bradycardia/hypotension) were 0%/0%/0% and 7.5%/7.5%/5% (P?=?0.030). However, these rates were less than the reported side effect occurrence rate, and no additional medication was needed.DEX enables conscious sedation, and is useful not only for patient and endoscopist satisfaction but also for pain relief. DEX is an effective sedation method for colorectal ESD.
| S-EPMC6030068 | biostudies-other
Project description:AIMS:To evaluate the short- and long-term outcomes of 3 different endoscopic dissection techniques for upper gastrointestinal (GI) submucosal tumours (SMTs). METHODS:Data for 135 patients withGI SMTs who underwent multiband mucosectomy (MBM), endoscopic submucosal dissection (ESD), or endoscopic submucosal excavation (ESE) were retrospectively assessed. The en bloc resection rate, endoscopic complete resection rate, operation time, potential complications and local recurrence rate were compared. RESULTS:No significant differences were observed in the rate of endoscopic complete resections and pathologic complete resections among the three groups. For SMTs >?15?mm in width, the lowest en bloc resection rate was found for MBM (P?=?0.000). MBM was also associated with the shortest procedure time, lowest perforation rate and lowest rate of major bleeding. ESE was the most effective procedure for muscularis propria (MP) lesions but was associated with the longest operation time (P?<?0.01). The ESD and ESE groups had similar perforation rates (P?>?0.05). No differences were observed in 4-year local recurrence rates among the groups (P?=?0.945). CONCLUSIONS:MBM is a simple and effective method for the treatment of small SMTs and achieves clinical success rates similar to those of ESD and ESE. However, ESD and ESE are preferable for larger and deep lesions and are associated with a longer operation time. Nonetheless, all 3 techniques resulted in a low 4-year local recurrence rate. Large-scale randomized clinical trials are needed to further investigate these results.
| S-EPMC6731551 | biostudies-literature
Project description:Purpose: Liver tissue regeneration is vital in the restoration of liver function after hepatectomy and liver transplantation. Dexmedetomidine is a highly selective alpha2-adrenergic receptor (A2R) agonist, whichis regarded as a sedative and analgesic medication that is frequently used intra- and postoperatively in hepatic surgery. Owing to its critical role in the protection of multiple organs, the purpose of this study is to investigate the effects of dexmedetomidine on liver regeneration. Methods:Dexmedetomidine 25 μg.kg-1 was injected intraperitoneally 30 minutes before a 70% hepatectomy performed in mice. Blood and liver samples were obtained for analysis after 48 hours. Mouse primary hepatocytes (MPHMPHs) were incubated with 10 μM dexmedetomidine for 24 hours, then analyzed for cell proliferation from mRNA and protein levels. Transcriptome sequencing revealed the potential mechanism of dexmedetomidine promoting liver regeneration, verified by western blot analysis. Loss of function analysis was performed using the selective corresponding antagonist of Dexmedetomidine . Results:25 μg.kg-1 Ddexmedetomidine significantly promoted mouse liver regeneration in vivo. The liver/body weight ratio was elevated following dexmedetomidine preconditiontreatment. ImmunohistochemistryProliferative markers of Ki67, PCNA and cyclin-D1 suggested more hepatocytes enter a state of proliferatimore cell proliferationon in dexmedetomidine group via immunohistochemistry. These effects were also phenocopied in vitro Incubating withwhere 10 µM dexmedetomidine increased MPH proliferation in vitro, detected by Edu and Ki67 immunofluorescence staining. The expression of cyclins, PCNA mRNA, protein expression levels of cyclins and PCNA were higher with dexmedetomidine treatment in vivo and in vitro. The p-AKT, p-GSK3beta and beta-catenin expression levels were elevated by dexmedetomidine. The effect of dexmedetomidine on MPH proliferation and p-AKT, p-GSK3beta and beta-catenin expressionse phenomenon was blocked by atipamezole (ATI, alpha2 adrenoceptor antagonist) pretreatment. Conclusion:Dexmedetomidine activates AKT/GSK3beta/beta-catenin pathway to promote enhance liver regeneration via binding the alpha-2 adrenoreceptor, which would shed light on a potential therapeutic clinical role to protect liver function in a broad of hepatic surgery.
2022-11-01 | GSE188867 | GEO
Project description:This study evaluated the possibility of endoscopic submucosal dissection (ESD) for early gastric cancer with papillary adenocarcinoma (EGC-PAC). PAC, an uncommon pathologic type of stomach cancer, is classified into differentiated-type histology. However, aggressive features, including a high rate of submucosal invasion, lymphovascular invasion (LVI), and lymph node metastasis (LNM), have been reported in studies with surgical specimens. Treatment outcomes of ESD for EGC-PAC have not been precisely demonstrated. Core databases were sought for the following inclusion criteria: studies of endoscopic resection or surgery of EGC-PAC presenting the following therapeutic indicators; en bloc resection, complete resection, curative resection, recurrence, complications associated with procedures, LVI, or LNM that enabled an analysis of ESD possibility. Overall, 15 studies were included for systematic review. Frequent submucosal invasion and high LVI were noted in EGC-PAC. However, PAC was not significantly associated with LNM. Pooled en bloc resection, complete resection, and curative resection rates were 89.7% (95% confidence interval: 55.3%-98.4%), 85.3% (67.7%-94.2%), and 67% (43%-84.5%), respectively. No LNM was observed if EGC-PAC satisfied the curative resection criteria. ESD seems technically feasible, although a high LVI rate results in a lower rate of curative resection.
| S-EPMC7290846 | biostudies-literature