Confocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China
Abstract Background Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited...
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-021-01312-x |
| _version_ | 1818642778054197248 |
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| author | Lihua Chu Jialian Zhao Cheng Sheng Min Yue Feifei Wang Shengwen Song Baoli Cheng Guohao Xie Xiangming Fang |
| author_facet | Lihua Chu Jialian Zhao Cheng Sheng Min Yue Feifei Wang Shengwen Song Baoli Cheng Guohao Xie Xiangming Fang |
| author_sort | Lihua Chu |
| collection | DOAJ |
| description | Abstract Background Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions. Methods A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed. Patients enrolled were allocated into the propofol-based sedated group (n = 126) and the un-sedated group (n = 100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnosis and pathological diagnosis. Reporting followed the STROBE guidelines. Results The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in the sedated group was 0.97 (95 % CI: 0.95 to 0.99), which was higher than that in the un-sedated group (0.88 (95 % CI: 0.80 to 0.97), P = 0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P = 0.0008 and P = 0.0001, respectively). For patients considered as high-grade intraepithelial neoplasia or EGC by endoscopists, they would not get biopsy during CLE but receive endoscopic submucosal dissection (ESD) subsequently, and the misdiagnosis rate of CLE was 0 % in the sedated group and 27.59 % (95 % CI: 10.30–44.91 %) in the un-sedated group (P = 0.006). Conclusions Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions (intraepithelial neoplasia OR intestinal metaplasia). |
| first_indexed | 2024-12-16T23:48:28Z |
| format | Article |
| id | doaj.art-43ccbeae630b4184b2942003b1caa407 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-16T23:48:28Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-43ccbeae630b4184b2942003b1caa4072022-12-21T22:11:25ZengBMCBMC Anesthesiology1471-22532021-03-012111710.1186/s12871-021-01312-xConfocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in ChinaLihua Chu0Jialian Zhao1Cheng Sheng2Min Yue3Feifei Wang4Shengwen Song5Baoli Cheng6Guohao Xie7Xiangming Fang8Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang UniversityDepartment of Anesthesiology, the Children’s Hospital, College of Medicine, Zhejiang UniversityDepartment of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang UniversityDepartment of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang UniversityDepartment of Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang UniversityDepartment of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang UniversityDepartment of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang UniversityDepartment of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang UniversityDepartment of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang UniversityAbstract Background Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions. Methods A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed. Patients enrolled were allocated into the propofol-based sedated group (n = 126) and the un-sedated group (n = 100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnosis and pathological diagnosis. Reporting followed the STROBE guidelines. Results The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in the sedated group was 0.97 (95 % CI: 0.95 to 0.99), which was higher than that in the un-sedated group (0.88 (95 % CI: 0.80 to 0.97), P = 0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P = 0.0008 and P = 0.0001, respectively). For patients considered as high-grade intraepithelial neoplasia or EGC by endoscopists, they would not get biopsy during CLE but receive endoscopic submucosal dissection (ESD) subsequently, and the misdiagnosis rate of CLE was 0 % in the sedated group and 27.59 % (95 % CI: 10.30–44.91 %) in the un-sedated group (P = 0.006). Conclusions Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions (intraepithelial neoplasia OR intestinal metaplasia).https://doi.org/10.1186/s12871-021-01312-xPropofol‐based sedationConfocal laser endomicroscopyEarly gastric cancerPrecancerous lesions |
| spellingShingle | Lihua Chu Jialian Zhao Cheng Sheng Min Yue Feifei Wang Shengwen Song Baoli Cheng Guohao Xie Xiangming Fang Confocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China BMC Anesthesiology Propofol‐based sedation Confocal laser endomicroscopy Early gastric cancer Precancerous lesions |
| title | Confocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China |
| title_full | Confocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China |
| title_fullStr | Confocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China |
| title_full_unstemmed | Confocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China |
| title_short | Confocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China |
| title_sort | confocal laser endomicroscopy under propofol based sedation for early gastric cancer and pre cancerous lesions is associated with better diagnostic accuracy a retrospective cohort study in china |
| topic | Propofol‐based sedation Confocal laser endomicroscopy Early gastric cancer Precancerous lesions |
| url | https://doi.org/10.1186/s12871-021-01312-x |
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