Influence of Esophageal Endoscopic Submucosal Dissection on the Changes of Energy Metabolism during the Perioperative Period

SIMPLE SUMMARY: This study aimed to measure resting energy expenditure (REE) and assess the physical invasiveness of esophageal endoscopic submucosal dissection (ESD) during perioperative periods. In addition, the factors affecting changes in REE were investigated. Subjects were examined using an indirect calorimeter and the stress factor was calculated based on basal energy expenditure and body weight. REE/body weight on the day following ESD was significantly higher than that of the same day. The stress factor on the day after ESD was 1.11. The increase in WBC, neutrophil, and CRP levels was associated with the change in REE ratio. Among the factors affecting changes in energy metabolism, only the total resection area was associated with changes in REE. It is suggested that patients who undergo esophageal ESD require more attention in perioperative management when the resection area of the lesions is larger. ABSTRACT: Esophageal endoscopic submucosal dissection (ESD) is considered to be more complex than gastric ESD. This study aimed to assess the physical invasiveness of esophageal ESD during perioperative periods by measuring resting energy expenditure (REE). The factors affecting REE that could be used to identify patients requiring perioperative management were also investigated. Overall, 75 patients who had undergone esophageal ESD were prospectively enrolled. REE, body weight, and basal energy expenditure were measured on the day of and the day following ESD. The mean REE/body weight was 20.2 kcal/kg/day on the day of ESD and significantly increased to 23.0 kcal/kg/day one day after ESD. The stress factor on the day after ESD was 1.11. White blood cell, neutrophil, and C-reactive protein levels increased on the day after ESD and correlated with the changes in REE. Among the factors including age, body mass index, total resection area, operation time, and sarcopenia, only the total resection area was associated with changes in REE. In conclusion, energy metabolism increases during the perioperative period for esophageal ESD. The increase in the stress factor for esophageal ESD was higher than that in gastric and colorectal ESD. Furthermore, patients with large resection areas require greater attention in perioperative management.