Risk factors and prognosis of pulmonary complications after endoscopic submucosal dissection for gastric neoplasia

Background: Hospital-acquired pneumonia after an endoscopic submucosal dissection (ESD) can prolong the patient's stay in the hospital, leading to greater healthcare costs. However, little is known of the characteristics and risk factors associated with this complication. Aims: To analyze the clinical features of pneumonia after ESD and to suggest a treatment plan. Methods: This was a retrospective study in which the cases of 1,661 consecutive patients who underwent ESD for 1,725 lesions between January 2008 and June 2011 were reviewed. Results: Of the 1,661 patients who underwent ESD during the study period, 38 were subsequently diagnosed with pneumonia, and an additional 18 patients exhibited lung consolidation, based on chest radiography, without respiratory signs or symptoms. The remaining 1,605 patients showed neither lung consolidation on chest radiography nor respiratory signs/symptoms. Continuous propofol infusion with intermittent or continuous administration of an opioid [odds ratio (OR) 4.498, 95 % confidence interval (CI) 2.267-8.923], a procedure time of >2 h (OR 2.900, 95 % CI 1.307-6.439), male gender (OR 2.835, 95 % CI 1.164-6.909), and age >75 years (OR 2.765, 95 % CI 1.224-6.249) were independent risk factors for pneumonia after ESD. In patients with only lung consolidation (without respiratory signs and symptoms), the length of hospital stay and prognosis were not affected by antibiotics use. Conclusions: Deep sedation under continuous propofol infusion with opioid injection during ESD may be a risk factor for pneumonia.