| Theme |
Patient Management During Endoscopic Examination and Treatment |
| Title |
Patient Care for Esophageal Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection |
| Author |
Toshiyuki Wakatsuki |
Department of Gastroenterology, Saku Central Hospital |
| Author |
Tsuneo Oyama |
Department of Gastroenterology, Saku Central Hospital |
| Author |
Yoshinori Miyata |
Department of Gastroenterology, Saku Central Hospital |
| Author |
Akihisa Tomori |
Department of Gastroenterology, Saku Central Hospital |
| Author |
Akiko Takahashi |
Department of Gastroenterology, Saku Central Hospital |
| Author |
Tomoaki Shinohara |
Department of Gastroenterology, Saku Central Hospital |
| [ Summary ] |
Esophageal cancer patients have many risks including liver dysfunction, emphysema, and cardiovascular diseases. Therefore, various plans are required in order to perform safer ESD procedures. Warfarin and antiplatelet drugs should be withdrawn a few days before ESD to decrease the risk of hemorrhage. Blood pressure, heart rate and oxygen saturation should be checked and recorded during ESD. An automatic leg massager is useful to prevent deep venous thrombosis. Insertion of an over tube is useful to prevent aspirational pneumonia.
Benzodiazepines with intravenous narcotics are commonly used for sedation. However, control of sedation is sometimes difficult, because alcoholics often have a resistance to benzodiazepines. Therefore, sedation for esophageal ESD is more difficult than that for gastric ESD. Sometimes sedation with multiple medications is necessary for esophageal ESD. Overall conditions should be observed when complications such as perforation have occurred. Vital signs, hematemesis, melena, chest pain, emphysema and body temperature should be scrutinized after ESD. Warfarin and antiplatelet drugs should be restarted soon after ESD to prevent cardiovascular disease because the risk of delayed bleeding after esophageal ESD is rare. |