Commentary on “Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia”
Abstract
Esophageal cancer affects more than 450,000 people worldwide, and its incidence has increased owing to aging and population growth. With advances in endoscopic techniques, the use of endoscopic submucosal dissection (ESD) procedures as an alternative to surgical treatment for patients with node-negative early esophageal cancer is also increasing, and the favorable outcomes of ESD for esophageal cancer have been reported. The demand for esophageal ESD has been increasing especially for older patients or those with comorbidities because of the risk of morbidity and mortality associated with esophageal surgery. Therefore, finding strategies for performing esophageal ESD more effectively and safely is important. For stable procedures, several methods have been introduced and attempted. For example, carbon dioxide gas is known to reduce the procedure time, abdominal pain, and complications after the procedure because it is absorbed more rapidly than room air. General anesthesia (GA) could also be performed in a stable procedure by minimizing patient movement induced by breathing or belching, and the risk of aspiration pneumonia is expected to be reduced by applying positive pressure. The effectiveness of ESD under GA was reported in some studies on gastric and esophageal ESD. By analyzing 39 esophageal and 66 gastric ESD procedures, Rong et al. reported that ESD under GA was associated with a shorter procedure time and higher rate of patient satisfaction than midazolam sedation.…
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