Initial experience of spinal anesthesia for recto-sigmoid endoscopic submucosal dissection: a case series

Aims Endoscopic submucosal dissection (ESD), considered to be the optimal resection technique for early colorectal cancer, requires the patient to be in still position for a long period of time. While conscious sedation may allow involuntary movements of the patient, deep sedation carries a higher risk of sedation-related adverse events (AEs), especially in frail patients. Spinal anesthesia (SA), a simple analgesic technique providing a deep and fast nerve block, has not been used in gastrointestinal endoscopy so far. We aimed to evaluate the feasibility and performance of SA in large recto-sigmoid lesion ESD [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12].

Methods In this prospective case series study, we report an initial experience of ESD for large (>35mm) recto-sigmoid laterally spreading tumors (LSTs) using SA. We evaluated technical success, sedation/anesthesia-related periprocedural AEs and pain, measured via visual assessment scale (VAS).

Results Eleven patients were included in the study (Table1). Technical success was achieved in 100% of cases. No life-threatening sedation-related AEs were observed. Both one case (9.1%) of acute urinary retention and mild acute kidney injury were observed. All patients reported VAS=0 during procedure. Two out of 11 (18.2%) patients reported pain (VAS=3 and 7) on the day after the procedure only. No need for additional drug administration including opioids and/or benzodiazepines was needed. Median hospital stay was 1 day ([Fig. 1]).

Fig. 1

Conclusions This is the first report of the use of SA in gastrointestinal endoscopy. Our initial experience in large recto-sigmoid lesion ESD suggests that SA is feasible and safe, and may be a valuable option especially for long-lasting procedures in frail patients.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

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Publication History

Article published online:
14 April 2023