Incidence rates, risk factors, and outcomes of aspiration pneumonia after gastric endoscopic submucosal dissection: A systematic review and meta-analysis

J Gastroenterol Hepatol. 2021 Jun;36(6):1457-1469. doi: 10.1111/jgh.15359. Epub 2021 Jan 4.


Background and aim: The risk and prognosis of aspiration pneumonia (AP) after endoscopic submucosal dissection (ESD) are inconsistent among studies. We aim to estimate the incidence, risk factors, and outcome of AP in patients after gastric ESD.

Methods: PubMed, EMBASE, Cochrane Library, and Web of Knowledge were searched for relevant articles from inception until April 2020. Data involving the incidence, risk factors, and outcomes were extracted. Pooled incidence, odds ratios (ORs), or standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated.

Results: Forty records involving 48 674 subjects were finally included. The pooled incidence of AP after gastric ESD was 1.9% (95% CI, 1.2-2.7) via the double arcsine transformation method and 1.6% (1.1-2.5%) via the logit transformation method. Risk factors analyses revealed that old age (OR, 2.52; 95% CI, 1.99-3.18), comorbid pulmonary disease (2.49; 1.66-3.74), comorbid cerebrovascular disease (2.68; 1.05-6.85), remnant stomach (4.91; 1.83-13.14), sedation with propofol (2.51; 1.48-4.28), and long procedural duration (count data: 5.20, 1.25-21.7; measurement data: 1.01, 1.01-1.02) were related to the occurrence of AP. Patients with AP had a longer hospital stay (SMD, 0.56; 95% CI, 0.25-0.87) than those without AP.

Conclusions: About 1.9% (1.2-2.7%) of the patients who receive gastric ESD may develop AP, resulting in prolonged hospital stay. More attention should be paid in patients who are older; have comorbidities such as pulmonary diseases, cerebrovascular diseases, or gastric remnant; or require a long procedural duration or deep sedation with propofol.

Keywords: aspiration pneumonia; endoscopic submucosal dissection; incidence; outcome; risk factors.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Cerebrovascular Disorders / epidemiology
  • Comorbidity
  • Deep Sedation
  • Endoscopic Mucosal Resection / adverse effects*
  • Endoscopic Mucosal Resection / methods
  • Female
  • Humans
  • Incidence
  • Length of Stay
  • Lung Diseases / epidemiology
  • Male
  • Operative Time
  • Pneumonia, Aspiration / epidemiology*
  • Pneumonia, Aspiration / etiology*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology*
  • Prognosis
  • Propofol
  • Risk Factors


  • Propofol