Vol. 1 No. 1 (2025), Original Article
Vol. 1 No. 1 (2025)

Dexmedetomidine as an Adjunctive Sedative in Patients Undergoing Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis

Original Article
Published 2025-03-11
Hazem Abosheaishaa
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai / NYC Health + Hospitals Queens, New York, USA. image/svg+xml
https://orcid.org/0000-0002-5581-8702
Abdallfatah Abdallfatah
Faculty of Medicine, October 6 University, Giza, Egypt. image/svg+xml
https://orcid.org/0000-0002-5670-2234
Abdelmalek Abdelghany
Faculty of Medicine, October 6 University, Giza, Egypt. image/svg+xml
https://orcid.org/0009-0002-5399-1795
Arshia Sethi
Internal Medicine Department, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals Queens, NY, USA. image/svg+xml
https://orcid.org/0000-0001-5018-5611
Abdellatif Ismail
University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA. image/svg+xml
https://orcid.org/0009-0006-1854-4569
Doha Mohamed
Faculty of Medicine, October 6 University, Giza, Egypt.
Moataz Aboeldahb
Mayo Clinic Gastroenterology and Hepatology, Rochester, Minnesota, USA image/svg+xml
https://orcid.org/0009-0000-8595-1785
Omar Abdelhalim
Internal Medicine Department, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals Queens, NY, USA. image/svg+xml
https://orcid.org/0009-0004-7528-9045
Islam Mohamed
Department of Gastroenterology, University of Missouri, Columbia, Missouri, USA
https://orcid.org/0000-0002-0740-8960
Ahmed Y. Azzam
Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA. image/svg+xml
https://orcid.org/0000-0002-4256-0159
Muhammed Amir Essibayi
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA image/svg+xml
https://orcid.org/0000-0001-8325-2382
David J. Altschul
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA image/svg+xml
https://orcid.org/0000-0002-5130-1378
Mahmoud Nassar
Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA.
https://orcid.org/0000-0002-5401-9562
Mohammad Bilal
Division of Gastroenterology and Hepatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA.
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Keywords

Dexmedetomidine
Endoscopic submucosal dissection
ESD
Precedex
Systematic Review
Meta-Analysis

How to Cite

1.
Abosheaishaa H, Abdallfatah A, Abdelghany A, et al. Dexmedetomidine as an Adjunctive Sedative in Patients Undergoing Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis. ASIDE GI. 2025;1(1):7-14. doi:10.71079/ASIDE.GI.0109257
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Abstract

Introduction: Endoscopic submucosal dissection (ESD) is a technique for removing dysplastic lesions in the gastrointestinal tract but carries risks like pain and perforation. Dexmedetomidine, an α2-receptor agonist, offers potential benefits as an adjunct sedative during ESD by providing anxiolysis and analgesia. This systematic review and meta-analysis assesses its efficacy and safety.

Methodology: We searched databases including Embase, Medline/PubMed, Scopus, and Web of Science up to April 21, 2024, following PRISMA guidelines. Eligible studies used dexmedetomidine with other sedatives for ESD. We analyzed outcomes such as en-bloc and complete resection rates, sedation duration, and adverse events, using RevMan for meta-analysis with a random-effects model.

Results: The initial search retrieved 216 studies and after screening, eight studies were included in the final analysis. Dexmedetomidine showed no significant difference in en-bloc or complete resection rates compared to controls. Sedation and procedure times were similar between the two groups as well. Dexmedetomidine significantly reduced restlessness (OR 0.15, 95% CI:0.07 to 0.29) and increased bradycardia (OR 7.15, 95% CI 3.17 to 16.11) compared to controls. Upon subgroup analysis, Dexmedetomidine plus Propofol, and Dexmedetomidine plus Midazolam, revealed the same findings regarding restlessness and bradycardia compared to controls which confirmed the adjunctive effects of Dexmedetomidine.

Conclusion: Dexmedetomidine as an adjunctive sedative appears safe and effective in ESD, reducing restlessness without significant adverse events. The risk of bradycardia is increased, which may be reflective of reduced physiological stress. Future studies should explore optimal dosing and compare Dexmedetomidine with other sedatives in diverse populations.

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