OA04.6. Clinical Efficacy and Safety of Dexmedetomidine Hydrochloride Sedation During Esophageal Endoscopic Submucosal Dissection

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ID: 325677
2026
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Ranked #68 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Esophageal Cancer: Non-Surgical Treatment of Esophageal Cancer Background Many patients with esophageal cancer have a history of heavy alcohol consumption. As benzodiazepines may depress respiration when used as a sedative during esophageal endoscopic submucosal dissection (ESD), our institution routinely uses dexmedetomidine hydrochloride (DEX). This study evaluated the clinical utility and safety of sedation with DEX during esophageal ESD. Methods We retrospectively evaluated 632 lesions in 523 patients who underwent esophageal ESD with dexmedetomidine at our hospital between April 2020 and October 2025. Seventy-eight patients who were treated under general anesthesia, eight patients in whom DEX was contraindicated due to cardiac disease or other clinical reasons, and 11 patients who underwent simultaneous esophageal and gastric ESD were excluded. In the remainder of the patients, DEX 6 μg/kg/hour was administered for 10 minutes as a loading infusion, followed by a continuous maintenance infusion at 0.4 μg/kg/hour. Clinical characteristics, procedural outcomes, and adverse events related to DEX use were then evaluated. Vital sign changes during treatment were also analyzed to assess the safety and feasibility of DEX sedation during esophageal ESD. Results The median age was 70 years (range: 30–95 years), and 409 (78.2%) and 114 (21.8%) patients were male and female, respectively. The median alcohol intake was 200 g/week. The mean specimen size was 32 mm (range: 11–94 mm). The lesions were located in the cervical esophagus (1.2%), upper thoracic esophagus (12.0%), mid-thoracic esophagus (59.1%), lower thoracic esophagus (25.1%), and esophagogastric junction (2.3%). The mean procedural time was 62 minutes, and the mean DEX administration time was 72.2 minutes. Pethidine hydrochloride was additionally administered at a mean dose of 43 mg. ESD was completed in 522 patients(99.8%) and discontinued in one patient due to inadequate movement control. DEX infusion was reduced or temporarily discontinued in 24 patients (4.5%) without discontinuing the treatment. Hypotension, oxygen desaturation, and bradycardia occurred in 85, 28, and 149 patients. All the patients improved with appropriate management. No significant risk factors were identified. Conclusion DEX sedation during esophageal ESD occasionally causes temporary circulatory and respiratory changes. However, these events can be managed safely with appropriate, supportive treatment. The procedural completion rate remained high, and no serious complications were observed, suggesting that DEX is a safe and effective sedative for esophageal ESD and may be a useful alternative to conventional sedation methods, especially in patients with alcohol-related risk factors.
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Authors Sorano Ichiya, Toshiro Iizuka, Mari Iseki, Yasuhiro Oka, Eriko Noma
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.034
URL
https://doi.org/10.1093/dote/doag077.034
Keywords Keywords not found

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