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Abstract
Background The optimal anesthetic approach for endoscopic submucosal dissection (ESD) of colorectal lesions remains undetermined. This study aimed to compare the efficacy and safety of general anesthesia with endotracheal intubation (GA) versus monitored anesthesia care without intubation (MAC) in patients undergoing colorectal ESD.
Methods From April 2018 to February 2024, patients undergoing colorectal ESD at the First Affiliated Hospital of Soochow University were identified; those with simultaneous endoscopic mucosal resection (EMR) were excluded. A total of 370 patients were enrolled: 157 in the GA group and 213 in the MAC group. Clinicopathologic, endoscopic procedure, and anesthetic data were collected.
Results A total of 382 colorectal lesions were resected by ESD, with no anesthetic-related adverse events. The GA group had a complete resection rate of 90.1% and an en bloc resection rate of 91.9%, with two cases of perforation and two of bleeding. The MAC group had a complete resection rate of 95.6% and an en bloc resection rate of 96.3%, with one case of bleeding. Compared to the MAC group, a higher proportion of elderly patients with lesions located in the right colon, larger than 2 cm in diameter, and of epithelial origin were in the GA group. In the MAC group, the average operation time for right colon lesions was longer than for left colon and rectal lesions, whereas the average operation time was similar between any part of the colorectum in the GA group (IDDF2024-ABS-0416 Figure 1). In both groups, lesions larger than 2 cm in diameter or of epithelial origin had longer average operation times compared to smaller or non-epithelial lesions.
Conclusions Both GA and MAC are safe and effective anesthetic approaches for colorectal ESD. Besides lesions larger than 2 cm in diameter and of epithelial origin, GA is preferred for those located in the right colon.