Spinal anesthesia for endoscopic submucosal dissection of large rectosigmoid lesions: Feasibility study

Abstract

Background and study aims Colorectal endoscopic submucosal dissection (ESD) is often challenging and time-consuming. Prolonged sedation and general anesthesia are associated with a relevant risk of anesthesia-related adverse events (ARAEs), especially in elderly and frail patients. Spinal anesthesia (SA), a simple technique providing analgesia and motor block without systemic drug administration, has never been described in gastrointestinal endoscopy. We assessed the feasibility of SA in colorectal lesion ESD.

Patients and methods We retrospectively collected data on all consecutive patients who underwent ESD for colorectal laterally spreading tumors (LSTs) under SA in our center during the last 3 years. We evaluated the rates of technical success, i.e. ESD completion under SA without need of conversion to deep sedation or general anesthesia, and ARAEs after SA.

Results ESD under SA was performed on 20 rectosigmoid LSTs ≥ 35 mm. Technical success was achieved in 95.0% of cases (19/20), while one patient (5.0%) required conversion to deep sedation. Two patients (10.0%) experienced acute urinary retention that was successfully treated with temporary catheterization.

Conclusions Our initial experience suggests that SA for ESD of large rectosigmoid LSTs is feasible, and it may prove to be a valuable option, especially for elderly and frail patients.

Keywords

Quality and logistical aspects - Sedation and monitoring - Endoscopy Lower GI Tract - Polyps / adenomas / ... - Endoscopic resection (polypectomy, ESD, EMRc, ...)

Publication History

Received: 22 May 2024

Accepted after revision: 18 September 2024

Accepted Manuscript online:
14 October 2024

Article published online:
17 December 2024

• References

• 1 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy 2022; 54: 591-622
• 2 Tanaka S, Kashida H, Saito Y. et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2020; 32: 219-239
• 3 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86
• 4 Wadhwa V, Issa D, Garg S. et al. Similar Risk of cardiopulmonary adverse events between propofol and traditional anesthesia for gastrointestinal endoscopy: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2017; 15: 194-206
• 5 Manno M, Deiana S, Gabbani T. et al. Implementation of the European Society of Gastrontestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) sedation training course in a regular endoscopy unit. Endoscopy 2021; 53: 65-71
• 6 Leung CM, Hui RW. Comparing general anaesthesia versus sedation for endoscopic submucosal dissection: results from a systematic review and meta-analysis. Anaesthesiol Intensive Ther 2023; 55: 9-17
• 7 Martin LD, Mhyre JM, Shanks AM. et al. 3,423 emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology 2011; 114: 42-48
• 8 Rattenberry W, Hertling A, Erskine R. Spinal anaesthesia for ambulatory surgery. BJA Educ 2019; 19: 321-328
• 9 Schubert AK, Wiesmann T, Wulf H. et al. Spinal anesthesia in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37: 109-121
• 10 Koo C-H, Ryu J-H. Anesthetic considerations for urologic surgeries. Korean J Anesthesiol 2020; 73: 92-102
• 11 Frisch NB, Darrith B, Hansen DC. et al. Single-dose lidocaine spinal anesthesia in hip and knee arthroplasty. Arthroplast Today 2018; 4: 236-239
• 12 Smith LM, Cozowicz C, Uda Y. et al. Neuraxial and combined neuraxial/general anesthesia compared to general anesthesia for major truncal and lower limb surgery: A systematic review and meta-analysis. Anesthesia Analgesia 2017; 125: 1931-1945
• 13 Cortese G, Sales G, Maiolo G. et al. Effectiveness of spinal anesthesia in transanal endoscopic microsurgery: a 3-year experience. Minerva Anestesiol 2018; 84: 712-719
• 14 Berger Y, Gingold-Belfer R, Khatib M. et al. Transanal endoscopic microsurgery under spinal anaesthesia. J Minim Access Surg 2021; 17: 490-494
• 15 von Elm E, Altman DG, Egger M. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-1457
• 16 Mason KP, Green SM. Piacevoli Q el al. Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: a consensus document from the World SIVA International Sedation Task Force. Br J Anaesth 2012; 108: 13-20
• 17 Matsumoto S, Yoshida Y. Endoscopic submucosal dissection for colorectal tumors in the dentate line area and those adjacent to the dentate line. Austin J Gastroenterol 2015; 2: 1037
• 18 Baldini G, Bagry H, Aprikian A. et al. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 2009; 110: 1139-1157
• 19 Khanna A, Saxena R, Dutta A. et al. Comparison of ropivacaine with and without fentanyl vs bupivacaine with fentanyl for postoperative epidural analgesia in bilateral total knee replacement surgery. J Clin Anesth 2017; 37: 7-13
• 20 Fonseca NM, Guimarães GMN, Pontes JPJ. et al. Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials. Braz J Anesthesiol 2023; 73: 198-216
• 21 Ellakany MH. Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery. Anesth Essays Res 2014; 8: 223-228