Subscribe to RSS
DOI: 10.1055/s-0034-1392537
Factors influencing development of pain after gastric endoscopic submucosal dissection: a randomized controlled trial
Publication History
submitted 14 October 2014
accepted after revision 12 May 2015
Publication Date:
10 July 2015 (online)
![](https://www.thieme-connect.de/media/endoscopy/201512/lookinside/thumbnails/11562_10-1055-s-0034-1392537-1.jpg)
Background and study aims: Endoscopic submucosal dissection (ESD) is widely used for local treatment of gastric neoplasms. Although ESD-related complications such as bleeding and perforation have been reported, data are currently lacking on the development of pain, which is one of the most common adverse events after ESD. The aim of the current study was to investigate the incidence and clinicopathologic risk factors of pain after ESD.
Patients and methods: A prospective randomized controlled study was conducted to evaluate 156 patients with gastric neoplasms treated by ESD at Gangnam Severance Hospital between April 2011 and August 2013. All patients were randomly assigned to treatment with intravenous proton pump inhibitor (PPI) either before or after ESD. Acid infusion tests were performed in a subgroup of 21 patients to investigate the mechanism of pain after ESD.
Results: The incidence of moderate-to-severe pain after ESD was significantly lower in the group that received preprocedure PPI (44.9 %) compared to those who did not (62.8 %). Female sex, tumors of the distal stomach (i. e. lower third), baseline dyspeptic symptoms, and positive acid infusion testing were variables that correlated significantly with the development of pain after ESD, although female sex was not significant in multivariate analysis.
Conclusions: Patients with tumors of the distal stomach and baseline dyspeptic symptoms were more likely to develop pain after gastric ESD. Hypersensitivity to acid was one mechanism fueling post-ESD pain. Prophylactic PPI treatment was effective at reducing post-ESD pain.
Trial registered at Clinicaltrials.gov (NCT02254889).
-
References
- 1 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
- 2 Toyonaga T, Man-i M, East JE et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
- 3 Ono S, Kato M, Ono Y et al. Effects of preoperative administration of omeprazole on bleeding after endoscopic submucosal dissection: a prospective randomized controlled trial. Endoscopy 2009; 41: 299-303
- 4 Kim M, Jeon SW, Cho KB et al. Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study. Surg Endosc 2013; 27: 1372-1378
- 5 Choi HS, Kim KO, Chun HJ et al. The efficacy of transdermal fentanyl for pain relief after endoscopic submucosal dissection: a prospective, randomised controlled trial. Dig Liver Dis 2012; 44: 925-929
- 6 Turk DC. Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clin J Pain 2002; 18: 355-365
- 7 Stewart WF, Ricci JA, Chee E et al. Lost productive time and cost due to common pain conditions in the US workforce. JAMA 2003; 290: 2443-2454
- 8 Lee HW, Lee H, Chung H et al. The efficacy of single-dose postoperative intravenous dexamethasone for pain relief after endoscopic submucosal dissection for gastric neoplasm. Surg Endosc 2014; 28: 2334-2341
- 9 Kim B, Lee H, Chung H et al. The efficacy of topical bupivacaine and triamcinolone acetonide injection in the relief of pain after endoscopic submucosal dissection for gastric neoplasia: a randomized double-blind, placebo-controlled trial. Surg Endosc 2015; 29: 714-722
- 10 Oshima T, Okugawa T, Tomita T et al. Generation of dyspeptic symptoms by direct acid and water infusion into the stomachs of functional dyspepsia patients and healthy subjects. Aliment Pharmacol Ther 2012; 35: 175-182
- 11 Miwa H, Nakajima K, Yamaguchi K et al. Generation of dyspeptic symptoms by direct acid infusion into the stomach of healthy Japanese subjects. Aliment Pharmacol Ther 2007; 26: 257-264
- 12 Ishii M, Kusunoki H, Manabe N et al. Evaluation of duodenal hypersensitivity induced by duodenal acidification using transnasal endoscopy. J Gastroenterol Hepatol 2010; 25: 913-918
- 13 Kim SH, Moon JS, Youn YH et al. Management of the complications of endoscopic submucosal dissection. World J Gastroenterol 2011; 17: 3575-3579
- 14 Jeon SW, Jung MK, Cho CM et al. Predictors of immediate bleeding during endoscopic submucosal dissection in gastric lesions. Surg Endosc 2009; 23: 1974-1979
- 15 Uesato M, Nabeya Y, Akai T et al. Salivary amylase activity is useful for assessing perioperative stress in response to pain in patients undergoing endoscopic submucosal dissection of gastric tumors under deep sedation. Gastric Cancer 2010; 13: 84-89
- 16 Lee H, Cheoi KS, Chung H et al. Clinical features and predictive factors of coagulation syndrome after endoscopic submucosal dissection for early gastric neoplasm. Gastric Cancer 2012; 15: 83-90
- 17 Cha JM, Lim KS, Lee SH et al. Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study. Endoscopy 2013; 45: 202-207
- 18 Onogi F, Araki H, Ibuka T et al. “Transmural air leak”: a computed tomographic finding following endoscopic submucosal dissection of gastric tumors. Endoscopy 2010; 42: 441-447
- 19 Kellow JE, Borody TJ, Phillips SF et al. Human interdigestive motility: variations in patterns from esophagus to colon. Gastroenterology 1986; 91: 386-395
- 20 Lemann M, Dederding JP, Flourie B et al. Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. The irritable stomach syndrome. Dig Dis Sci 1991; 36: 1249-1254
- 21 Kiriyama S, Oda I, Nishimoto F et al. Pilot study to assess the safety of local lidocaine injections during endoscopic submucosal dissection for early gastric cancer. Gastric Cancer 2009; 12: 142-147