Colorectal (Colon or Rectal) Cancer
Conditions
Keywords
ESD, Spinal Anesthesia, colorectal lesions, LST, Laterally Spreading Tumor, endoscopic submucosal dissection, deep sedation
Brief summary
The investigators collected data on all consecutive patients who underwent ESD for recto-sigmoid laterally spreading tumors (LSTs) \>35 mm under SA between January 2021 and March 2024. The investigators evaluated the technical success and safety of SA in terms of ARAEs, and pain, measured via visual assessment scale (VAS).
Detailed description
Background and study aim: Endoscopic submucosal dissection (ESD) of large colorectal lesions requires the patient to be in a still position for a long time. Both deep sedation and general anesthesia carry a substantial risk of anesthesia-related adverse events (ARAEs), especially in frail patients. Conversely, mild-to-moderate sedation does not prevent involuntary movements of the patient. Spinal anesthesia (SA) is a safe and simple technique that provides analgesia and motor block without systemic drug administration or orotracheal intubation. As the use of SA in colorectal endoscopic resections has not been described so far, we aimed to evaluate the feasibility and performance of SA in large (\>35 mm) recto-sigmoid lesion ESD. Patients and methods: The investigators collected data on all consecutive patients who underwent ESD for recto-sigmoid laterally spreading tumors (LSTs) \>35 mm under SA between January 2021 and March 2024. The investigators evaluated the technical success and safety of SA in terms of ARAEs, and pain, measured via visual assessment scale (VAS). The secondary endpoints were as follows: intra- and post-procedural need for additional opioid or other analgesic drug administration, ESD-related adverse eventss, length of hospital stay, and median ESD duration.
Interventions
PROCEDUREESD of large LSTs under SA
endoscopic submucosal dissection of large colorectal lesions under spinal anesthesia
Sponsors
Azienda USL Modena
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* age ≥18 years * American Society of Anaesthesiologists (ASA) score I-IV * ability to give informed consent
Exclusion criteria
* age \<18 years * ASA score V * allergy to medications used for spinal anesthesia * pregnancy * breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Technical success of ESD under SA | Immediately after the procedure | Technical success was defined as completion of the ESD under SA without the need of conversion to deep sedation or general anesthesia. |
| Safety of ESD under SA | periprocedurally | Safety was evaluated intra- and post-procedurally by recording anesthesia-related adverse events (ARAEs). Major ARAEs included death, anaphylaxis and severe cardiorespiratory or neurologic AEs. Minor ARAEs included any other cardiorespiratory or neurologic AEs, headache, acute urinary retention and itching. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Median ESD duration | Immediately after the procedure | Median ESD duration |
| Length of hospital stay | At delivery | length of hospital stay |
| Intra- and post-procedural need for additional opioid or other analgesic drug administration | periprocedurally | Intra- and post-procedural need for additional opioid or other analgesic drug administration |
| ESD- and colonoscopy-related AEs | periprocedurally | Perforation, bleeding, post-coagulation syndrome, adverse events related to endoscopic bowel preparation |
Countries
Italy
Outcome results
None listed