Assessment of physical stress during the perioperative period of endoscopic submucosal dissection

Abstract

The advantage of endoscopic submucosal dissection (ESD) is that it is less invasive than surgery. ESD is one of the best treatments for older patients as surgery in this age group of patients is difficult. However, it is unclear how much lower the physical stress of ESD is compared with that of surgery. Thus, objective methods are required to assess physical stress in patients who have undergone ESD. The current review of ESD aimed to summarize the recent advancements in the assessment of physical stress during the perioperative period, focusing on changes in energy metabolism and serum opsonic activity (SOA). Based on metabolic changes, resting energy expenditure (REE) was measured using an indirect calorimeter. The stress factor calculated from the REE and the basal energy expenditure computed using the Harris-Benedict equation can be used to assess physical stress. SOA was assessed using the chemiluminescence method, wherein the use of chemiluminescent probes (i.e., lucigenin and luminol) allowed quantification of reactive oxygen species generated by neutrophils. Using an auto luminescence analyzer, the results were evaluated based on the maximum light emission and area under the emission curve. These quantifiable results revealed the minimal invasiveness of ESD.

Keywords: Physical stress, Endoscopic submucosal dissection, Indirect calorimeter, Resting energy expenditure, Chemiluminescence, Serum opsonic activity

Core Tip: Concerning the degree of physical invasiveness of patients before and after endoscopic submucosal dissection (ESD), assessment methods based on changes in energy metabolism using an indirect calorimeter and serum opsonic activity (SOA) measured by lucigenin- and luminol-dependent chemiluminescence are useful and easy to measure. During the perioperative period of ESD, the increase in resting energy expenditure and stress factor were lower than those reported for surgery, and SOA changes involved a minor increase in the production of lower-toxicity reactive oxygen species. These assessment methods demonstrated that the physical stress of ESD is less invasive than that of surgery.