Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.11985
Revised: February 25, 2014
Accepted: May 28, 2014
Published online: September 14, 2014
Endoscopic submucosal dissection (ESD) has been proposed as the gold standard in the treatment of early gastric cancer because it facilitates a more accurate histological assessment and reduces the risk of tumor recurrence. However, the time course of ESD for large gastric tumors is frequently prolonged because of the tumor size and technical difficulties and typically requires higher doses of sedative and pain-controlling drugs. Sedative or anesthetic drugs such as midazolam or propofol are used during the procedure. Therapeutic endoscopy of early gastric cancers can often be performed with only moderate sedation. Compared with midazolam, propofol has a very fast onset of action, short plasma half-life and time to achieve sedation, faster time to recovery and discharge, and results in higher patient satisfaction. For overall success, maintaining safety and stability not only during the procedure but also subsequently in the recovery room and ward is necessary. In obese patients, it is recommended that the injected dose be based on a calculated standard weight. Cooperation between gastroenterologists, surgeons, and anesthesiologists is imperative for a successful ESD procedure.
Core tip: According to the literature, endoscopic submucosal dissection (ESD) has been proposed as the gold standard in the treatment of early gastric cancer. However, ESD requires safe sedation management. This review covers safe sedation using propofol and other sedative drugs in the context of the available literature. Moreover, understanding safe sedation could be important in managing perioperative patients with gastric ESD. To this end, we suggest that sedation using propofol is safe and results in patient satisfaction after endoscopic gastric treatment for ESD.