Clinical Endoscopy

Original Articles

Anesthesia care provider sedation versus conscious sedation for endoscopic ultrasound–guided tissue acquisition: a retrospective cohort study: Sneha Shaha, Yinglin Gao, Jiahao Peng, Kendrick Che, John J. Kim, Wasseem Skef; Clin Endosc 2023;56(5):658-665. Published online July 3, 2023; DOI: https://doi.org/10.5946/ce.2023.006

Background
/Aims: We aimed to study the effects of sedation on endoscopic ultrasound–guided tissue acquisition.
Methods
We conducted a retrospective study evaluating the role of sedation in endoscopic ultrasound–guided tissue acquisition by comparing two groups: anesthesia care provider (ACP) sedation and endoscopist-directed conscious sedation (CS).
Results
Technical success was achieved in 219/233 (94.0%) in the ACP group and 114/136 (83.8%) in the CS group (p=0.0086). In multivariate analysis, the difference in technical success between the two groups was not significant (adjusted odds ratio [aOR], 0.5; 95% confidence interval [CI], 0.234–1.069; p=0.0738). A successful diagnostic yield was present in 146/196 (74.5%) in the ACP group and 66/106 (62.3%) in the CS group, respectively (p=0.0274). In multivariate analysis, the difference in diagnostic yield between the two groups was not significant (aOR, 0.643; 95% CI, 0.356–1.159; p=0.142). A total of 33 adverse events (AEs) were observed. The incidence of AEs was significantly lower in the CS group (5/33 CS vs. 28/33 ACP; OR, 0.281; 95% CI, 0.095–0.833; p=0.022).
Conclusions
CS provided equivalent technical success and diagnostic yield for malignancy in endoscopic ultrasound–guided tissue acquisition. Increased AEs were associated with anesthesia for the endoscopic ultrasound–guided tissue acquisition.

Citations

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Impact of Sedation Regimen on Diagnostic Adequacy in Endoscopic ultrasonography-Guided Tissue Acquisition of Solid Pancreatic Lesions
Luciano Lenz, Silvia Kim, Bruno Martins, Leika Miyahara Felipe, Sergio E. Matuguma, Andressa Abnader Machado, Renata Nobre, Marcelo Simas de Lima, Gustavo A. de Paulo, Adriana V. Safatle-Ribeiro, Fauze Maluf-Filho
Endoscopy International Open.2026;[Epub] CrossRef

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Necessity of pharyngeal anesthesia during transoral gastrointestinal endoscopy: a randomized clinical trial: Tomoyuki Hayashi, Yoshiro Asahina, Yasuhito Takeda, Masaki Miyazawa, Hajime Takatori, Hidenori Kido, Jun Seishima, Noriho Iida, Kazuya Kitamura, Takeshi Terashima, Sakae Miyagi, Tadashi Toyama, Eishiro Mizukoshi, Taro Yamashita; Clin Endosc 2023;56(5):594-603. Published online April 12, 2023; DOI: https://doi.org/10.5946/ce.2022.182

Graphical Abstract Abstract PDF

Background
/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation.
Methods
This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA– groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA– group in terms of the pharyngeal observation success rate.
Results
The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA–) groups were 84.0% and 72.0%, respectively. The PA– group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0–10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA– group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate between the groups.
Conclusions
Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.

Citations

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Comparison of NaPSflex and standard nasal cannula during sedation for gastrointestinal endoscopy in obese patients: a randomized cohort trial
Xiao Liang, Jinming Liu, Wanning Wang, Qian Cao, Guowei Zhu, Zhen Gu, Miao Zhou, Zui Zou, Chao Han
International Journal of Surgery.2026; 112(2): 3474. CrossRef

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Review

Anesthesia for Advanced Endoscopic Procedures: Basavana Goudra, Monica Saumoy; Clin Endosc 2022;55(1):1-7. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.236

Abstract PDF

The gastrointestinal endoscopy paradigm is rapidly changing, and technological advancements are largely responsible. In tandem, anesthesia providers are adapting to the changing needs and demands. The challenges are unique. Complications arising from the procedures are both routine, such as aspiration and hypoxia, and procedure specific, such as bleeding, pneumothorax, pneumopericardium, and pneumoperitoneum. It is crucial for the anesthesia provider to have a good understanding of the techniques employed by the endoscopist. A higher index of suspicion is also essential to diagnose and appropriately manage many of the complications. In this review, an effort is made to discuss both procedural aspects and anesthesia challenges. We hope that both endoscopists and anesthesia providers will benefit from this review.

Citations

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Caner Genç, Sezgin Bilgin, Hasan Çetinkaya, Hatice Selçuk Kuşderci, Sevda Akdeniz, Esra Turunç, Burhan Dost, Özgür Kömürcü
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Gut and Liver.2024; 18(1): 10. CrossRef
Optimizing perioperative anesthesia strategies for safety and high-quality during painless gastrointestinal endoscopy diagnosis and treatment
Le Xu, Yanhong Li, Hong Zheng, Rurong Wang
Anesthesiology and Perioperative Science.2024;[Epub] CrossRef
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Ghazala Maryam, Rashk E-Hinna, Saman Sardar, Jahangir Khan, Javaria Isram, Fayyaz Hassan
Scripta Medica.2024; 55(6): 749. CrossRef
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Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
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Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. CrossRef
Case of Concomitant Endoscopic Treatment of Achalasia with Superficial Esophageal Cancer
Myung-Hun Lee, Kyoungwon Jung, Jae Hyun Kim, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park
The Korean Journal of Gastroenterology.2023; 82(5): 248. CrossRef

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Original Article

Clinical Outcomes and Adverse Events of Gastric Endoscopic Submucosal Dissection of the Mid to Upper Stomach under General Anesthesia and Monitored Anesthetic Care: 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; Clin Endosc 2022;55(1):77-85. Published online July 5, 2021; DOI: https://doi.org/10.5946/ce.2021.002

Abstract PDF Supplementary Material

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.

Citations

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Ursula Galway, Basem B. Abdelmalak
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Fan Bu, Sheng-Yu Zhang, Zi-Jia Liu
World Journal of Gastrointestinal Surgery.2026;[Epub] CrossRef
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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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General Anesthesia and Endoscopic Upper Gastrointestinal Tumor Resection
Seung Hyun Kim
Journal of Digestive Cancer Research.2023; 11(3): 125. CrossRef
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Choy-May Leung, Rex Wan-Hin Hui
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Is General Anesthesia Needed in Endoscopic Submucosal Dissection for Lesions Located in the Mid to Upper Stomach?
Prasit Mahawongkajit, Jirawat Swangsri
Clinical Endoscopy.2022; 55(1): 43. CrossRef
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Eun Jeong Gong, Chang Seok Bang
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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
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Jie Zhang, Yanlei Chen, Zhiwu Liu, Zhihao Pan, Jinghua Pan
Journal of Oncology.2022; 2022: 1. CrossRef

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8 Web of Science
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Case Report

Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia: Tomoaki Yamasaki, Yuhei Sakata, Takehisa Suekane, Hiroko Nebiki; Clin Endosc 2021;54(6):916-919. Published online November 12, 2020; DOI: https://doi.org/10.5946/ce.2020.220

Abstract PDF

Mallory-Weiss tears (MWT) are occasionally encountered during endoscopic procedures. Esophageal endoscopic submucosal dissection (ESD) is widely performed under general anesthesia to avoid unexpected body movements. We present the case of a 68-year-old woman with squamous cell carcinoma. Although ESD was performed under general anesthesia, a gastric perforation at the MWT caused by gastric inflation was observed after the procedure. The perforation was closed endoscopically, and she was discharged without any sequelae. Although general anesthesia is useful for esophageal ESD, it should be noted that it can cause MWT, and in rare cases, gastric perforation, due to gastric inflation during the procedure.

Citations

Citations to this article as recorded by

Gastric Perforation Encountered during Duodenal Stent Insertion
Sung Woo Ko, Hoonsub So, Sung Jo Bang
The Korean Journal of Gastroenterology.2022; 80(5): 221. CrossRef

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106 Download
1 Web of Science
1 Crossref

Review

Anesthetic Consideration for Peroral Endoscopic Myotomy: Yun-Sic Bang, Chunghyun Park; Clin Endosc 2019;52(6):549-555. Published online July 10, 2019; DOI: https://doi.org/10.5946/ce.2019.033

Abstract PDF

A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.

Citations

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Tension pneumoperitoneum combined with CO2 gas embolism during peroral endoscopic myotomy: a case report and review of literature
Shui Yu, Xiaofeng Hu, Jingyan Xu, Qin Wang, Jingxiong Zhang, Kai Sun, Xiaoxia Zhou
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Advances and challenges in peroral endoscopic myotomy: Safety, precision, and post-procedure management
Grigorios Christodoulidis, Kyriaki Tsagkidou, Konstantinos Eleftherios Koumarelas, Marina Nektaria Kouliou
World Journal of Gastroenterology.2025;[Epub] CrossRef
Factors predicting insufflation-related events in peroral endoscopic myotomy procedures
Feng-Pai Tsai, Chien-Chuan Chen, Min-Hsiu Liao, Hsiu-Po Wang, Ming-Shiang Wu, Jia-Feng Wu, Shou-Zen Fan, Ping-Huei Tseng
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Third space endoscopy pulmonary complications and chylothorax post peroral endoscopic myotomy
Ahmed Tawheed, Alaa Ismail, Ahmed El-Tawansy, Karim Maurice, Ahmed Ali, Amr El-Fouly, Ahmad Madkour
World Journal of Methodology.2025;[Epub] CrossRef
Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part II) – Best Practice Techniques: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
David J. Tate, Enrique Rodriguez de Santiago, Michele Montori, Vikash Lala, Lynn K. Debels, Eduardo Albéniz, Isis K. Araujo, Eduardo Guimarães Hourneaux de Moura, Alanna Ebigbo, Pietro Familiari, Paul Fockens, Henriette Heinrich, Oleksandr Kiosov, Helmut
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Journal of Clinical Medicine.2025; 14(18): 6504. CrossRef
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Nermin Mutlu Bilgiç, Zuhal Çalışkan, Oğuzhan Öztürk, Mehmet Ali Saruhan, Kamil Ozdil
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Sweekar K. Shenoy, Arjun Talapatra, MV Eeshwar
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Rohan Yewale, Amit Daphale, Ashish Gandhi, Amol Bapaye
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Rodrigo Duarte-Chavez, Amy Tyberg, Avik Sarkar, Haroon M. Shahid, Bhargav Vemulapalli, Sardar Shah-Khan, Monica Gaidhane, Michel Kahaleh
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Zachary N. Weitzner, Steven Cha, Ronald Challita, Olujimi Ajijola, Shumpei Mori, Kalyanam Shivkumar, Erik Dutson, Alireza Sedarat
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Amaldev Ashok, Lakshmi Kumar, Anoop K. Koshy
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Anesthesia for Advanced Endoscopic Procedures
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Original Article

Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia: Koichi Hamada, Koichiro Kawano, Atsushi Yamauchi, Ryota Koyanagi, Yoshinori Horikawa, Shinya Nishida, Yoshiki Shiwa, Noriyuki Nishino, Michitaka Honda; Clin Endosc 2019;52(3):252-257. Published online May 23, 2019; DOI: https://doi.org/10.5946/ce.2018.151

Abstract PDF

Background
/Aims: Evidence that general anesthesia (GA) reduces the operative time of esophageal endoscopic submucosal dissection (ESD) is currently insufficient. This study aims to evaluate the efficacy and safety of esophageal ESD under GA.
Methods
A total of 227 lesions from 198 consecutive patients with superficial esophageal neoplasms treated by ESD at 3 Japanese institutions between April 2011 and September 2017 were included in this retrospective study. For ESD, GA and deep sedation (DS) were used in 102 (51.5%, GA group) and 96 patients (48.5%, DS group), respectively.
Results
There were no statistically significant differences in age, sex, or comorbidities between the groups. In the GA group, the tumor size was larger (21 [3–77] mm vs. 14 [3–63] mm, p<0.001), luminal circumference was larger (≥2/3; 13.9% vs. 5.4%, p=0.042), procedure time was shorter (28 [5–202] min vs. 40 [8–249] min, p<0.001), and submucosal dissection speed was faster (25.2 [7.8–157.2] mm2 /min vs. 16.2 [2.4–41.3] mm2 /min, p<0.001). The rates of intraoperative perforation and aspiration pneumonia were lower in the GA group, but the difference did not achieve statistical significance (p=0.242 and p=0.242).
Conclusions
GA shortens the procedure time of esophageal ESD.

Citations

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Yusuke Takahashi, Kotaro Shibagaki, Satoshi Kotani, Shinsuke Suemitsu, Shinsaku Tanaka, Masahito Aimi, Koichiro Furuta, Hideaki Mori, Norihisa Ishimura, Tetsuro Nikai, Shunji Ishihara
Endoscopy International Open.2026;[Epub] CrossRef
Characteristics of cases for which esophageal endoscopic submucosal dissection under general anesthesia is recommended
Atsushi Goto, Koichi Hamabe, Shunsuke Ito, Shinichi Hashimoto, Jun Nishikawa, Taro Takami
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Seung Hyun Kim
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Choy-May Leung, Rex Wan-Hin Hui
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Seiichiro Abe, Yuichiro Hirai, Takeshi Uozumi, Mai Ego Makiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda, Yutaka Saito
DEN Open.2022;[Epub] CrossRef
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Dai Kubota, Yoshiki Sakaguchi, Sayaka Nagao, Yosuke Tsuji, Mitsuhiro Fujishiro
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Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia
Tomoaki Yamasaki, Yuhei Sakata, Takehisa Suekane, Hiroko Nebiki
Clinical Endoscopy.2021; 54(6): 916. CrossRef
Feasibility of the lidocaine injection method during esophageal endoscopic submucosal dissection
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