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Bupivacaine

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We collected data on all consecutive patients who underwent ESD for recto-sigmoid laterally spreading tumors (LSTs) \>35 mm under SA.

SA was carried out in a sitting position, following a strictly aseptic technique. After recognition of L2-L3 intervertebral space through landmark technique, a 25 Gauge needle was inserted and the correct positioning was confirmed by detecting free flow of cerebrospinal fluid. Subsequently, 10-12 mg of hyperbaric bupivacaine + sufentanil 2 mcg according to the decision of the anesthetist was administered intrathecally without barbotage.

Subsequently, the patient underwent ESD of the colorectal lesion.

endoscopic submucosal dissection of large colorectal lesions under spinal anesthesia

ESD of large LSTs under SA

Mauro Manno, MD

The investigators collected data on all consecutive patients who underwent ESD for recto-sigmoid laterally spreading tumors (LSTs) \>35 mm under SA between January 2021 and March 2024. The investigators evaluated the technical success and safety of SA in terms of ARAEs, and pain, measured via visual assessment scale (VAS).

Background and study aim: Endoscopic submucosal dissection (ESD) of large colorectal lesions requires the patient to be in a still position for a long time. Both deep sedation and general anesthesia carry a substantial risk of anesthesia-related adverse events (ARAEs), especially in frail patients. Conversely, mild-to-moderate sedation does not prevent involuntary movements of the patient. Spinal anesthesia (SA) is a safe and simple technique that provides analgesia and motor block without systemic drug administration or orotracheal intubation. As the use of SA in colorectal endoscopic resections has not been described so far, we aimed to evaluate the feasibility and performance of SA in large (\>35 mm) recto-sigmoid lesion ESD.

Patients and methods: The investigators collected data on all consecutive patients who underwent ESD for recto-sigmoid laterally spreading tumors (LSTs) \>35 mm under SA between January 2021 and March 2024. The investigators evaluated the technical success and safety of SA in terms of ARAEs, and pain, measured via visual assessment scale (VAS). The secondary endpoints were as follows: intra- and post-procedural need for additional opioid or other analgesic drug administration, ESD-related adverse eventss, length of hospital stay, and median ESD duration.

Endoscopic Submucosal Dissection of Large Recto-sigmoid Lesions Under Spinal Anesthesia

Technical success was defined as completion of the ESD under SA without the need of conversion to deep sedation or general anesthesia.

Safety was evaluated intra- and post-procedurally by recording anesthesia-related adverse events (ARAEs). Major ARAEs included death, anaphylaxis and severe cardiorespiratory or neurologic AEs. Minor ARAEs included any other cardiorespiratory or neurologic AEs, headache, acute urinary retention and itching.

Intra- and post-procedural need for additional opioid or other analgesic drug administration

Perforation, bleeding, post-coagulation syndrome, adverse events related to endoscopic bowel preparation

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Endoscopic Submucosal Dissection of Large Recto-sigmoid Lesions Under Spinal Anesthesia	NCT06316401	Colorectal (Col...	ESD of large LS...	18 Years -	Azienda USL Modena
Endoscopic Submucosal Dissection of Large Recto-sigmoid Lesions Under Spinal Anesthesia	NCT06316401	Colorectal (Col...	ESD of large LS...	18 Years -	Azienda USL Modena
Endoscopic Submucosal Dissection of Large Recto-sigmoid Lesions Under Spinal Anesthesia	NCT06316401	Colorectal (Col...	ESD of large LS...	18 Years -	Azienda USL Modena

Spots Global Cancer Trial Database for esd of large lsts under sa