Comparing general anaesthesia versus sedation for endoscopic submucosal dissection: results from a systematic review and meta-analysis.

IF 1.6 Q2 ANESTHESIOLOGY Anaesthesiology intensive therapy Pub Date : 2023-01-01 DOI:10.5114/ait.2023.125416
Choy-May Leung, Rex Wan-Hin Hui
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Abstract

Endoscopic submucosal dissection (ESD) is an advanced endoscopic procedure for management of gastrointestinal tumours. ESD is usually performed under sedation. However, the use of general anaesthesia (GA) has been hypothesised to improve ESD outcomes. We performed a systematic review and meta-analysis to compare GA against sedation in ESD. A systematic literature search was performed on Cochrane Library, EMBASE and MEDLINE using the terms "General Anaesthesia", "Sedation" and "Endoscopic submucosal dissection". Original articles comparing GA versus sedation in ESD were included. The risk of bias and level of evidence were assessed by validated methods. This review is registered in PROSPERO (CRD42021275813). 176 articles were found in the initial literature search, and 7 articles (comprising 518 patients receiving GA and 495 receiving sedation) were included. Compared with sedation, GA was associated with higher en-bloc resection rates in oesophageal ESD (RR 1.05; 95% CI: 1.00-1.10; I 2 = 65%; P = 0.05). GA patients also trended towards lower rates of gastrointestinal perforation in all ESD procedures (RR 0.62; 95% CI: 0.21-1.82; I 2 = 52%; P = 0.06). Rates of intra- procedural desaturation and post-procedural aspiration pneumonia were lower in GA patients than in patients under sedation. The included studies had a moderate to high risk of bias, and the overall level of evidence was low. GA appears safe and feasible for ESD, yet high-quality trials will be required before GA can be regularly implemented for ESD.

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比较全身麻醉与镇静用于内镜下粘膜剥离:来自系统回顾和荟萃分析的结果。
内镜下粘膜剥离术(ESD)是一种用于胃肠道肿瘤治疗的先进内镜手术。ESD通常在镇静状态下进行。然而,全身麻醉(GA)的使用被假设可以改善ESD的结果。我们进行了系统回顾和荟萃分析来比较GA和镇静在ESD中的作用。在Cochrane Library、EMBASE和MEDLINE上进行系统的文献检索,检索词为“全身麻醉”、“镇静”和“内镜下粘膜夹层”。纳入了比较GA和镇静在ESD中的原始文章。偏倚风险和证据水平采用经过验证的方法进行评估。本综述已在PROSPERO注册(CRD42021275813)。初始文献检索共发现176篇文献,共纳入7篇文献(518例接受GA治疗,495例接受镇静治疗)。与镇静相比,GA与食管ESD的整体切除率较高相关(RR 1.05;95% ci: 1.00-1.10;I 2 = 65%;P = 0.05)。GA患者在所有ESD手术中也倾向于较低的胃肠道穿孔率(RR 0.62;95% ci: 0.21-1.82;I 2 = 52%;P = 0.06)。GA患者术中去饱和和术后吸入性肺炎的发生率低于镇静组。纳入的研究有中等到高度的偏倚风险,证据的总体水平较低。遗传算法在ESD中似乎是安全可行的,但在常规实施遗传算法之前,还需要进行高质量的试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
48
审稿时长
25 weeks
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