Subgroup analysis for studies which included only hospitalized patients.

<p>PPI, proton pump inhibitor; CI, confidence interval.</p

Subgroup analysis according to the cut-off value of serum magnesium levels.

<p>(A) Subgroup analysis for studies based on the 1.7 mg/dL of cut-off value. (B) Subgroup analysis for studies based on the 1.8 mg/dL of cut-off value. PPI, proton pump inhibitor; CI, confidence interval.</p

Characteristics of individuals in included studies.

a<p>This value was obtained through contact with the corresponding author of the study.</p><p>HypoMg, hypomagnesemia; PPI, proton pump inhibitor; DM, diabetes mellitus; GERD, gastroesophageal reflux disease; eGFR, estimated glomerular filtration rate; SD, standard deviation; OR, odds ratio; CI, confidence interval; NA, not available.</p><p>Characteristics of individuals in included studies.</p

Forest plots for risk of hypomagnesemia.

<p>PPI, proton pump inhibitor; CI, confidence interval.</p

Lesion characteristics and outcomes of endoscopic submucosal dissection.

<p>^aThe percentage of this variable was calculated based on the number of early gastric cancer lesions.</p><p>^bThe percentage of this variable was calculated based on the number of patients.</p><p>IMIE, intermittent midazolam/propofol injection by endoscopist; CPIA, continuous propofol infusion by anesthesiologist; ESD, endoscopic submucosal dissection; N/A, not applicable.</p><p>Lesion characteristics and outcomes of endoscopic submucosal dissection.</p

Assessing the Stability and Safety of Procedure during Endoscopic Submucosal Dissection According to Sedation Methods: A Randomized Trial

<div><p>Background</p><p>Although endoscopic submucosal dissection (ESD) is routinely performed under sedation, the difference in ESD performance according to sedation method is not well known. This study attempted to prospectively assess and compare the satisfaction of the endoscopists and patient stability during ESD between two sedation methods.</p><p>Methods</p><p>One hundred and fifty-four adult patients scheduled for ESD were sedated by either the IMIE (intermittent midazolam/propofol injection by endoscopist) or CPIA (continuous propofol infusion by anesthesiologist) method. The primary endpoint of this study was to compare the level of satisfaction of the endoscopists between the two groups. The secondary endpoints included level of satisfaction of the patients, patient’s pain scores, events interfering with the procedure, incidence of unintended deep sedation, hemodynamic and respiratory events, and ESD outcomes and complications.</p><p>Results</p><p>Level of satisfaction of the endoscopists was significantly higher in the CPIA Group compared to the IMIE group (IMIE vs. CPIA; high satisfaction score; 63.2% vs. 87.2%, <i>P</i>=0.001). The incidence of unintended deep sedation was significantly higher in the IMIE Group compared to the CPIA Group (IMIE vs. CPIA; 17.1% vs. 5.1%, <i>P</i>=0.018) as well as the number of patients showing spontaneous movement or those requiring physical restraint (IMIE vs. CPIA; spontaneous movement; 60.5% vs. 42.3%, <i>P</i>=0.024, physical restraint; 27.6% vs. 10.3%, <i>P</i>=0.006, respectively). In contrast, level of satisfaction of the patients were found to be significantly higher in the IMIE Group (IMIE vs. CPIA; high satisfaction score; 85.5% vs. 67.9%, <i>P</i>=0.027). Pain scores of the patients, hemodynamic and respiratory events, and ESD outcomes and complications were not different between the two groups.</p><p>Conclusion</p><p>Continuous propofol and remifentanil infusion by an anesthesiologist during ESD can increase the satisfaction levels of the endoscopists by providing a more stable state of sedation.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://www.clinicaltrial.gov/ct2/show/NCT01806753?term=nct01806753&rank=1" target="_blank">NCT01806753</a></p></div

Demographic data.

<p>Values are mean ± SD or n (%) of patients.</p><p>^aAntiplatelet agents or anticoagulants include aspirin, non-steroidal anti-inflammatory drugs and warfarin. The aforementioned drugs were discontinued in all patients prior to endoscopic submucosal dissection. ‘Use of antiplatelet agents or anticoagulants’ indicates the number of patients who took these medications.</p><p>IMIE, intermittent midazolam/propofol injection by endoscopist; CPIA, continuous propofol infusion by anesthesiologist; ASA, American Society of Anesthesiologists.</p><p>Demographic data.</p

Sedation-related data, speed of recovery and satisfaction scores.

<p>Values are mean ± SD or n (%) of patients.</p><p>IMIE, intermittent midazolam/propofol injection by endoscopist; CPIA, continuous propofol infusion by anesthesiologist; N/A, not applicable.</p><p>Sedation-related data, speed of recovery and satisfaction scores.</p

Modified Observer’s Assessment of Alertness/Sedation Scale [18].

<p>Modified Observer’s Assessment of Alertness/Sedation Scale [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0120529#pone.0120529.ref018" target="_blank">18</a>].</p

Adverse events.

<p>IMIE, intermittent midazolam/propofol injection by endoscopist; CPIA, continuous propofol infusion by anesthesiologist; MOAA/S, modified observer assessment of alertness/sedation.</p><p>Adverse events.</p