Diazepam during endoscopic submucosal dissection of gastric epithelial neoplasias

doi:10.4253/wjge.v4.i3.80

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Endosc. Mar 16, 2012; 4(3): 80-86
Published online Mar 16, 2012. doi: 10.4253/wjge.v4.i3.80

Table 1 Clinicopathological features of study subjects with a low (≤ 1.5 h ) or high (> 1.5 h) procedure time

Variables	Procedure time ≤1.5 h (n = 180)	Procedure time > 1.5 h (n = 151)	P value
Age (yr) (mean ± SD)	69.9 ± 9.1	69.0 ± 9.6	NS
Sex (male/female)	136/44	125/26	NS
Lifetime alcohol consumption (t) (mean ± SD)	0.30 ± 0.50	0.37 ± 0.48	NS
Smoking habit (Brink man index) (mean ± SD)	655.1 ± 777.7	563.0 ± 666.9	NS
Body weight (kg) (mean ± SD)	58.5 ± 10.9	60.1 ± 9.6	NS
Tumor size (mm) (mean ± SD)	13.3 ± 7.7	22.3 ± 16.0	< 0.001
Tumor location in stom ach (U + M/L)	54/126	94/57	< 0.001
Gross morphological type (0-I / IIa vs 0-IIb / IIc vs combined)	92/68/20	76/66/9	NS
Tumor depth (mucosa/ submucosa)	168/12	134/17	NS
Histological type (cancer /adenoma)	124/56	108/43	NS
Ulcerative findings, n (%)	2 (1.1)	30 (19.9)	< 0.001
Diazepam (mg) (mean ± SD)	9.9 ± 3.3	17.5 ± 7.8	< 0.001

SD: Standard deviation; NS: Not significant; U: Upper-third of the stomach; M: Middle-third of the stomach; L: Lower-third of the stomach.

Table 2 Clinical features of study subjects administered low- or high-dose of diazepam

Variables	Low-dose group (n = 252)	High-dose group(n = 79)	P value
Age (yr) (mean ± SD)	69.8 ± 9.1	68.3 ± 10.1	NS
Sex (male / female)	194/58	67/12	NS
Lifetime alcohol consumption (t) (mean ± SD)	0.30 ± 0.48	0.44 ± 0.52	0.032
Smoking habit (Brinkmanindex) (mean ± SD)	649.5 ± 767.7	497.8 ± 582.5	NS
Body weight (kg) (mean ± SD)	58.4 ± 10.3	62.0 ± 9.9	0.006
Anxiolytic agents (used/not used)	46/206	7/72	NS
ASA classification (ASA 1/ASA 2 / ASA 3)	48/151/53	20/47/12	NS
Comorbidities
Hypertension, n (%)	127 (50.3)	39 (49.4)	NS
Diabetes mellitus, n (%)	44 (17.5)	11 (13.9)	NS
Heart disease, n (%)	58 (23.0)	18 (22.8)	NS
Respiratory disease, n (%)	30 (11.9)	4 (5.1)	NS
Chronic renal failure, n (%)	4 (1.6)	0 (0)	NS
Liver cirrhosis, n (%)	21 (8.3)	5 (6.3)	NS

SD: Standard deviation; NS: Not significant; ASA: American Society of Anesthesiologists.

Table 3 Clinicopathological features and clinical outcomes of subjects administered low- or high-dose of diazepam

Variables	Low-dose group(n = 252)	High-dose group(n = 79)	P value
Tumor size (mm) (mean ± SD)	15.4 ± 10.1	23.9 ± 18.2	< 0.001
Tumor location in stomach (U and M/L)	96/156	52/27	< 0.001
Gross morphological type (0-I / IIa vs 0-IIb / IIc vs combined)	129/100/23	39/34/6	NS
Tumor depth (mucosa/ submucosa)	233/19	69/10	NS
Histological type (cancer/ adenoma)	176/76	56/23	NS
Ulcerative findings, n (%)	14 (5.6)	18 (22.8)	< 0.001
Resection style (en bloc/ piecemeal)	246/6	63/16	< 0.001
Postoperative bleeding, n (%)	1 (0.4)	1 (1.3)	NS
Perforation, n (%)	8 (3.2)	6 (7.6)	NS
Midazolam (added / not added)	43/209	20/59	NS

SD: Standard deviation; NS: Not significant; U: Upper-third of the stomach; M: Middle-third of the stomach; L: Lower-third of the stomach.

Table 4 Factors associated with the need for high doses of diazepam: Results of multivariate logistic analysis

Variable	P value	Odds ratio	95% CI
Lifetime alcohol consumption	0.041	1.74	1.02-2.97
Body weight	0.034	1.03	1.00-1.06
Tumor size	0	1.05	1.03-1.08
Location in stomach	0	2.87	1.61-5.12
Ulcerative findings	0.001	4.45	1.92-10.34

CI: Confidence interval.

Table 5 Comparison of need for high diazepam dose between subgroups stratified for lifetime alcohol consumption and body weight

Subgroup	Low-dose group(n = 252)	High-dose group (n = 79)	Odds ratio	95% CI
Alcohol > 0.4 t, BW > 60 kg	31	20	4.52	2.07-9.86
Alcohol > 0.4 t, BW ≤ 60 kg	38	17	3.13	1.43-6.88
Alcohol ≤ 0.4 t, BW > 60 kg	72	27	2.63	1.31-5.28
Alcohol ≤ 0.4 t, BW ≤ 60 kg	105	15	1	Referent

CI: Confidence interval. Alcohol: Lifetime alcohol consumption; BW: Body weight.

Table 6 Adverse events in patients administered a low vs high dose of diazepam

Variables	Low-dose group(n = 252)	High-dose group(n = 79)	P value
SpO2 < 90%, n (%)	70 (27.8)	18 (22.8)	NS
Blood pressure < 90 mmHg, n (%)	8 (3.2)	2 (2.5)	NS
Delayed awakening (flumazenil used/not used)	4/248	0/79	NS
Paradoxical excitement, n (%)	6 (2.4)	13 (16.5)	< 0.001

NS: Not significant.

Citation: 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
URL: https://www.wjgnet.com/1948-5190/full/v4/i3/80.htm
DOI: https://dx.doi.org/10.4253/wjge.v4.i3.80