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World J Gastroenterol. Aug 28, 2022; 28(32): 4508-4515
Published online Aug 28, 2022. doi: 10.3748/wjg.v28.i32.4508
Assessment of physical stress during the perioperative period of endoscopic submucosal dissection
Daisuke Chinda, Tadashi Shimoyama
Daisuke Chinda, Tadashi Shimoyama, Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
Daisuke Chinda, Division of Endoscopy, Hirosaki University Hospital, Hirosaki 036-8563, Japan
Tadashi Shimoyama, Department of Internal Medicine, Aomori General Health Examination Center, Aomori 030-0962, Japan
Author contributions: Chinda D and Shimoyama T designed the review; Chinda D interpreted the data and drafted the manuscript; Shimoyama T critically revised the paper.
Supported by the Karoji Memorial Fund for Medical Research.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tadashi Shimoyama, FACG, MD, PhD, Director, Department of Internal Medicine, Aomori General Health Examination Center, 2-12-19 Tsukuda, Aomori 030-0962, Japan. tsimo@hirosaki-u.ac.jp
Received: January 14, 2022
Peer-review started: January 14, 2022
First decision: April 16, 2022
Revised: April 28, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: August 28, 2022
Processing time: 224 Days and 1.1 Hours
Abstract

The advantage of endoscopic submucosal dissection (ESD) is that it is less invasive than surgery. ESD is one of the best treatments for older patients as surgery in this age group of patients is difficult. However, it is unclear how much lower the physical stress of ESD is compared with that of surgery. Thus, objective methods are required to assess physical stress in patients who have undergone ESD. The current review of ESD aimed to summarize the recent advancements in the assessment of physical stress during the perioperative period, focusing on changes in energy metabolism and serum opsonic activity (SOA). Based on metabolic changes, resting energy expenditure (REE) was measured using an indirect calorimeter. The stress factor calculated from the REE and the basal energy expenditure computed using the Harris-Benedict equation can be used to assess physical stress. SOA was assessed using the chemiluminescence method, wherein the use of chemiluminescent probes (i.e., lucigenin and luminol) allowed quantification of reactive oxygen species generated by neutrophils. Using an auto luminescence analyzer, the results were evaluated based on the maximum light emission and area under the emission curve. These quantifiable results revealed the minimal invasiveness of ESD.

Keywords: Physical stress; Endoscopic submucosal dissection; Indirect calorimeter; Resting energy expenditure; Chemiluminescence; Serum opsonic activity

Core Tip: Concerning the degree of physical invasiveness of patients before and after endoscopic submucosal dissection (ESD), assessment methods based on changes in energy metabolism using an indirect calorimeter and serum opsonic activity (SOA) measured by lucigenin- and luminol-dependent chemiluminescence are useful and easy to measure. During the perioperative period of ESD, the increase in resting energy expenditure and stress factor were lower than those reported for surgery, and SOA changes involved a minor increase in the production of lower-toxicity reactive oxygen species. These assessment methods demonstrated that the physical stress of ESD is less invasive than that of surgery.