Muraki Y, Enomoto S, Iguchi M, Niwa T, Maekita T, Yoshida T, Moribata K, Shingaki N, Deguchi H, Ueda K, Inoue I, Tamai H, Kato J, Fujishiro M, Ichinose M. Diazepam during endoscopic submucosal dissection of gastric epithelial neoplasias. World J Gastrointest Endosc 2012; 4(3): 80-86 [PMID: 22442745 DOI: 10.4253/wjge.v4.i3.80]
Corresponding Author of This Article
Shotaro Enomoto, MD, PhD, Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan. shoe@orion.ocn.ne.jp
Article-Type of This Article
Original Article
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Yosuke Muraki, Shotaro Enomoto, Mikitaka Iguchi, Toru Niwa, Takao Maekita, Takeichi Yoshida, Kosaku Moribata, Naoki Shingaki, Hisanobu Deguchi, Kazuki Ueda, Izumi Inoue, Hideyuki Tamai, Jun Kato, Masao Ichinose, Second Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama 641-0012, Japan
Mitsuhiro Fujishiro, Department of Endoscopy and Endoscopic Surgery, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan
Author contributions: Muraki Y drafted the manuscript; Enomoto S made preparations for this manuscript; Maekita T, Yoshida T, Moribata K, Shingaki N, Deguchi H, Ueda K, Inoue I, Tamai H and Kato J contributed to data acquisition; Iguchi M, Niwa T, Fujishiro M and Ichinose M contributed to the analysis, interpretation of the data and critical revision of the manuscript for important intellectual content. All of the authors approved the final manuscript.
Supported by A Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare of Japan, in part
Correspondence to: Shotaro Enomoto, MD, PhD, Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan. shoe@orion.ocn.ne.jp
Telephone: +81-73-447-1335 Fax: +81-73-445-3616
Received: September 7, 2011 Revised: January 17, 2012 Accepted: March 2, 2012 Published online: March 16, 2012
Abstract
AIM: To investigate risk factors and adverse events related to high-dose diazepam administration during endoscopic submucosal dissection for gastric neoplasias.
METHODS: Between February 2002 and December 2009, a total of 286 patients with gastric epithelial neoplasia underwent endoscopic submucosal dissection in our hospital. To achieve moderate sedation, 5-7.5 mg of diazepam was administered intravenously by non-anesthesiologists. Intermittent additional administration of 2.5-5 mg diazepam was performed if uncontrollable body movement of the patient was observed. All patients were classified into groups based on the required diazepam dose: low-dose (≤ 17.5 mg, n = 252) and high-dose (> 17.5 mg, n = 79).
RESULTS: Differences between the low- and high-dose diazepam groups were observed in lifetime alcohol consumption (0.30 ± 0.48 vs 0.44 ± 0.52 tons, P = 0.032), body weight (58.4 ± 10.3 vs 62.0 ± 9.9 kg, P = 0.006), tumor size (15 ± 10 vs 23 ± 18 mm, P < 0.001), lesion location (P < 0.001) and the presence of ulcerative findings (14/238 vs 18/61, P < 0.001). Multivariate analysis identified all five variables as independently related to required diazepam dosage. In terms of adverse reactions to diazepam administration, paradoxical excitement was significantly more frequent in the high-dose diazepam group (P < 0.001).
CONCLUSION: Intermittent administration of diazepam enabled safe completion of gastric endoscopic submucosal dissection except in patients who were alcohol abusers or obese, or who showed complicated lesions.
