{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:40:59Z","timestamp":1783341659951,"version":"3.54.6"},"reference-count":69,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T00:00:00Z","timestamp":1692748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Karoji Memorial Fund for Medical Research","award":["2021A"],"award-info":[{"award-number":["2021A"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>A novel treatment method for achalasia of the esophagus and related disorders is known as peroral endoscopic myotomy (POEM). This study aimed to calculate the resting energy expenditure (REE) and evaluated the degree of physical invasiveness based on metabolic changes during the perioperative period of POEM. Fifty-eight patients who underwent POEM were prospectively enrolled; REE, body weight (BW), and basal energy expenditure were measured on the day of POEM, postoperative day 1 (POD 1), and three days after POEM (POD 3). The median REE\/BW increased from 19.6 kcal\/kg on the day of POEM to 24.5 kcal\/kg on POD 1. On POD 3, it remained elevated at 20.9 kcal\/kg. The stress factor on POD 1 was 1.20. Among the factors, including the Eckardt score, operation time, and the length of myotomy, the length of myotomy was associated with changes in REE\/BW. During the perioperative period of POEM, the level of variation in energy expenditure was lower than that of esophageal cancer surgeries performed under general anesthesia. However, because the length of myotomy is a factor affecting changes in energy expenditure, careful perioperative management is desirable for patients with longer myotomy lengths.<\/jats:p>","DOI":"10.3390\/metabo13090969","type":"journal-article","created":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T08:20:30Z","timestamp":1692778830000},"page":"969","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessment of the Physical Invasiveness of Peroral Endoscopic Myotomy during the Perioperative Period Based on Changes in Energy Metabolism"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1690-5923","authenticated-orcid":false,"given":"Daisuke","family":"Chinda","sequence":"first","affiliation":[{"name":"Division of Endoscopy, Hirosaki University Hospital, Hirosaki 036-8563, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadashi","family":"Shimoyama","sequence":"additional","affiliation":[{"name":"Aomori General Health Examination Center, Aomori 030-0962, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sae","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatoshi","family":"Kaizuka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Yasuda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Akitaya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsu","family":"Arai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Sawada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Hayamizu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Tatsuta","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidezumi","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyuki","family":"Yanagimachi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6657-6446","authenticated-orcid":false,"given":"Tatsuya","family":"Mikami","sequence":"additional","affiliation":[{"name":"Center of Healthy Aging Innovation, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotake","family":"Sakuraba","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsaku","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0140-6736(13)60651-0","article-title":"Achalasia","volume":"383","author":"Boeckxstaens","year":"2014","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.jamcollsurg.2015.03.057","article-title":"Per-Oral Endoscopic Myotomy: A Series of 500 Patients","volume":"221","author":"Inoue","year":"2015","journal-title":"J. Am. Coll. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Sato, H., Takahashi, K., Mizuno, K.I., Hashimoto, S., Yokoyama, J., and Terai, S. (2018). A clinical study of peroral endoscopic myotomy reveals that impaired lower esophageal sphincter relaxation in achalasia is not only defined by high-resolution manometry. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0195423"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"562","DOI":"10.5056\/jnm21254","article-title":"Subtype of Achalasia and Integrated Relaxation Pressure Measured Using the Starlet High-resolution Manometry System: A Multicenter Study in Japan","volume":"28","author":"Tatsuta","year":"2022","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1007\/s00535-018-01544-8","article-title":"Epidemiological analysis of achalasia in Japan using a large-scale claims database","volume":"54","author":"Sato","year":"2019","journal-title":"J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.cgh.2016.08.030","article-title":"Incidence and Prevalence of Achalasia in Central Chicago, 2004-2014, Since the Widespread Use of High-Resolution Manometry","volume":"15","author":"Samo","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1136\/gut.33.2.155","article-title":"Achalasia complicated by oesophageal squamous cell carcinoma: A prospective study in 195 patients","volume":"33","author":"Meijssen","year":"1992","journal-title":"Gut"},{"key":"ref_8","first-page":"3717","article-title":"Clinicopathological studies of esophageal carcinoma in achalasia: Analyses of carcinogenesis using histological and immunohistochemical procedures","volume":"20","author":"Chino","year":"2000","journal-title":"Anticancer Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13023-015-0302-1","article-title":"Idiopathic (primary) achalasia: A review","volume":"10","author":"Patel","year":"2015","journal-title":"Orphanet. J. Rare Dis."},{"key":"ref_10","first-page":"1","article-title":"Complications of botulinum toxin injections for treatment of esophageal motility disorders","volume":"30","author":"Tack","year":"2017","journal-title":"Dis. Esophagus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1097\/MOG.0b013e328362292a","article-title":"The role of Botulinum toxin injection in the management of achalasia","volume":"29","author":"Ramzan","year":"2013","journal-title":"Curr. Opin. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"43","DOI":"10.4103\/1319-3767.126317","article-title":"Efficacy of pneumatic dilatation in Saudi achalasia patients","volume":"20","author":"Aljebreen","year":"2014","journal-title":"Saudi J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/SLA.0b013e31818e43ab","article-title":"Endoscopic and surgical treatments for achalasia: A systematic review and meta-analysis","volume":"249","author":"Campos","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1097\/SLA.0b013e318190a776","article-title":"Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: Long-term results","volume":"248","author":"Rebecchi","year":"2008","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1055\/s-0029-1244080","article-title":"Peroral endoscopic myotomy (POEM) for esophageal achalasia","volume":"42","author":"Inoue","year":"2010","journal-title":"Endoscopy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1111\/den.13239","article-title":"Clinical practice guidelines for peroral endoscopic myotomy","volume":"30","author":"Inoue","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.gie.2012.02.008","article-title":"Successful treatment of diffuse esophageal spasm by peroral endoscopic myotomy","volume":"77","author":"Shiwaku","year":"2013","journal-title":"Gastrointest. Endosc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E79","DOI":"10.1055\/s-0032-1309922","article-title":"Peroral endoscopic myotomy (POEM) for diffuse esophageal spasm","volume":"46","author":"Minami","year":"2014","journal-title":"Endoscopy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E585","DOI":"10.1055\/s-0042-105204","article-title":"Peroral endoscopic myotomy for Jackhammer esophagus: To cut or not to cut the lower esophageal sphincter","volume":"4","author":"Bechara","year":"2016","journal-title":"Endosc. Int. Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/dote.12182","article-title":"Jackhammer esophagus: High-resolution manometry and therapeutic approach using peroral endoscopic myotomy (POEM)","volume":"29","author":"Kandulski","year":"2016","journal-title":"Dis. Esophagus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E1137","DOI":"10.1055\/a-1198-4643","article-title":"Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: Results from the first prospective trial","volume":"8","author":"Ichkhanian","year":"2020","journal-title":"Endosc. Int. Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/BF02234297","article-title":"Comparative evaluation of surgical stress of laparoscopic and open surgeries for colorectal carcinoma","volume":"44","author":"Nishiguchi","year":"2001","journal-title":"Dis. Colon Rectum"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1007\/s11605-012-1880-z","article-title":"Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program","volume":"16","author":"Wang","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/DCR.0000000000001216","article-title":"C-Reactive Protein Values After Colorectal Resection: Can We Discharge a Patient With a C-Reactive Protein Value > 100? A Retrospective Cohort Study","volume":"62","author":"Benoit","year":"2019","journal-title":"Dis. Colon Rectum"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"8","DOI":"10.29271\/jcpsp.2019.01.8","article-title":"Effect of Remifentanil Combined Anesthesia on Cytokines and Oxidative Stress in Patients undergoing Laparoscopic Surgery for Colon Cancer","volume":"29","author":"Ding","year":"2019","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1034\/j.1399-6576.2003.00073.x","article-title":"Catecholamine release during laparoscopic fundoplication with high and low doses of remifentanil","volume":"47","author":"Myre","year":"2003","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3211","DOI":"10.1016\/j.clnu.2020.03.038","article-title":"Perioperative nutrition: Recommendations from the ESPEN expert group","volume":"39","author":"Lobo","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1017\/S0029665107005253","article-title":"Nutritional interventions in critical illness","volume":"66","year":"2007","journal-title":"Proc. Nutr. Soc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1177\/0148607191015006604","article-title":"Resting energy expenditure in cancer patients before and after gastrointestinal surgery","volume":"15","author":"Fredrix","year":"1991","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3164\/jcbn.10-83","article-title":"Resting energy expenditure in patients undergoing pylorus preserving pancreatoduodenectomies for bile duct cancer or pancreatic tumors","volume":"48","author":"Sasaki","year":"2011","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4508","DOI":"10.3748\/wjg.v28.i32.4508","article-title":"Assessment of physical stress during the perioperative period of endoscopic submucosal dissection","volume":"28","author":"Chinda","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kudo, S., Chinda, D., Shimoyama, T., Yasuda, K., Akitaya, K., Arai, T., Miyazawa, K., Hayamizu, S., Yanagimachi, M., and Tsukamoto, T. (2022). Influence of Esophageal Endoscopic Submucosal Dissection on the Changes of Energy Metabolism during the Perioperative Period. Cancers, 14.","DOI":"10.3390\/cancers14082015"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"164","DOI":"10.3164\/jcbn.18-12","article-title":"Estimation of perioperative invasiveness of colorectal endoscopic submucosal dissection evaluated by energy metabolism","volume":"63","author":"Chinda","year":"2018","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"153","DOI":"10.3164\/jcbn.17-16","article-title":"Energy metabolism during the perioperative period of gastric endoscopic submucosal dissection","volume":"61","author":"Chinda","year":"2017","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Minami, H., Isomoto, H., Miuma, S., Kobayashi, Y., Yamaguchi, N., Urabe, S., Matsushima, K., Akazawa, Y., Ohnita, K., and Takeshima, F. (2015). New endoscopic indicator of esophageal achalasia: \u201cpinstripe pattern\u201d. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0101833"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1007\/s00535-009-0179-7","article-title":"The appearance of rosette-like esophageal folds (\u201cesophageal rosette\u201d) in the lower esophagus after a deep inspiration is a characteristic endoscopic finding of primary achalasia","volume":"45","author":"Iwakiri","year":"2010","journal-title":"J. Gastroenterol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1365-2982.2011.01834.x","article-title":"Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography","volume":"24","author":"Bredenoord","year":"2012","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/nmo.12477","article-title":"International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0","volume":"27","author":"Kahrilas","year":"2015","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S1052-5157(18)30071-0","article-title":"Clinical presentations and complications of achalasia","volume":"11","author":"Eckardt","year":"2001","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1046\/j.1440-1681.29.s4.3.x","article-title":"Development and evaluation of a simple calorimeter for the measurement of resting metabolism","volume":"29","author":"Tamura","year":"2002","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1038\/sj.ejcn.1600604","article-title":"Precision and accuracy in a metabolic monitor for indirect calorimetry","volume":"52","author":"Wells","year":"1998","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1073\/pnas.4.12.370","article-title":"A Biometric Study of Human Basal Metabolism","volume":"4","author":"Harris","year":"1918","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1177\/014860717900300609","article-title":"Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance","volume":"3","author":"Long","year":"1979","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1159\/000375155","article-title":"Resting Energy Expenditure in Patients with Stroke during the Subacute Phases\u2014Relationships with Stroke Types, Location, Severity of Paresis, and Activities of Daily Living","volume":"39","author":"Kawakami","year":"2015","journal-title":"Cerebrovasc. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1097\/TP.0b013e31829d924e","article-title":"Resting energy expenditure, body composition, and dietary intake: A longitudinal study before and after liver transplantation","volume":"96","author":"Ferreira","year":"2013","journal-title":"Transplantation"},{"key":"ref_46","first-page":"555","article-title":"Energy expenditure measured using indirect calorimeter after minimally invasive esophagectomy in ventilated postoperative patients","volume":"23","author":"Yatabe","year":"2014","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.jpeds.2013.05.063","article-title":"Energy expenditure and nutritional status in pediatric patients before and after lung transplantation","volume":"163","author":"Kalnins","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/j.clnu.2020.11.012","article-title":"The centenary of the Harris-Benedict equations: How to assess energy requirements best? Recommendations from the ESPEN expert group","volume":"40","author":"Bendavid","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1177\/0885066617702077","article-title":"Are Predictive Energy Expenditure Equations in Ventilated Surgery Patients Accurate?","volume":"34","author":"Tignanelli","year":"2019","journal-title":"J. Intensive Care Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"3350","DOI":"10.1007\/s00268-018-4632-8","article-title":"Measurement of Total Liver Volume Using the Energy Expenditure: A New Formula","volume":"42","author":"Donadon","year":"2018","journal-title":"World J. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S0899-9007(96)00382-6","article-title":"Serial changes in contribution of substrates to energy expenditure after transthoracic esophagectomy for cancer","volume":"13","author":"Sato","year":"1997","journal-title":"Nutrition"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3164\/jcbn.11-13","article-title":"Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer","volume":"49","author":"Okamoto","year":"2011","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_53","first-page":"573","article-title":"Estimation of energy need-should stress factor and activity factor be considered?","volume":"25","author":"Inoue","year":"2010","journal-title":"JPEEN J. Parrenter. Eteral Nutr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.ejphar.2007.11.071","article-title":"Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators","volume":"583","author":"McEwen","year":"2008","journal-title":"Eur. J. Pharmacol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1002\/(SICI)1522-7243(199911\/12)14:6<331::AID-BIO556>3.0.CO;2-E","article-title":"Applicability of chemiluminescence to assess the degree of operative stress in patients undergoing spinal surgery","volume":"14","author":"Kowatari","year":"1999","journal-title":"Luminescence"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/BF00311429","article-title":"Association between elevated plasma granulocyte colony-stimulating factor and the degree of surgical stress in patients undergoing gastrointestinal surgery","volume":"25","author":"Yokota","year":"1995","journal-title":"Surg. Today"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1111\/j.1365-2044.1995.tb06137.x","article-title":"Effect of general anaesthesia and surgery on neutrophil function","volume":"50","author":"Khan","year":"1995","journal-title":"Anaesthesia"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/S0952-8180(97)00006-8","article-title":"Elevated plasma levels of interleukin-6, interleukin-8, and granulocyte colony-stimulating factor during and after major abdominal surgery","volume":"9","author":"Kato","year":"1997","journal-title":"J. Clin. Anesth."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1002\/jso.25822","article-title":"Prognostic value of muscle depletion assessed by computed tomography for surgical outcomes of cancer patients undergoing total esophagectomy and gastrectomy","volume":"121","author":"Menezes","year":"2020","journal-title":"J. Surg. Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1080\/10715762.2019.1681590","article-title":"Usefulness of serum opsonic activity measured by chemiluminescence method to assess the invasiveness of colorectal endoscopic mucosal dissection","volume":"54","author":"Chinda","year":"2020","journal-title":"Free Radic. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.jtcvs.2008.11.042","article-title":"Society of Thoracic Surgeons General Thoracic Surgery Database. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model","volume":"137","author":"Wright","year":"2009","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1111\/j.1440-1746.2012.07075.x","article-title":"Utility and problems of endoscopic submucosal dissection for early gastric cancer in elderly patients","volume":"27","author":"Tokioka","year":"2012","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e00404","DOI":"10.14309\/ctg.0000000000000404","article-title":"Risk Factors for Bleeding After Endoscopic Submucosal Dissection for Gastric Cancer in Elderly Patients Older Than 80 Years in Japan","volume":"12","author":"Sugimoto","year":"2021","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1159\/000512899","article-title":"Impact of BMI on Complications of Gastric Endoscopic Submucosal Dissection","volume":"39","author":"Kim","year":"2021","journal-title":"Dig. Dis."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Tachikawa, J., Chiba, H., Okada, N., Arimoto, J., Ashikari, K., Kuwabara, H., Nakaoka, M., Higurashi, T., Goto, T., and Nakajima, A. (2021). Impact of obesity in colorectal endoscopic submucosal dissection: Single-center retrospective cohort study. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01652-5"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s00535-009-0137-4","article-title":"Risk factors for complications of endoscopic submucosal dissection in gastric tumors: Analysis of 478 lesions","volume":"45","author":"Mannen","year":"2010","journal-title":"J. Gastroenterol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"6387","DOI":"10.1007\/s00464-021-08965-2","article-title":"The impact of sarcopenia on adverse events associated with gastric endoscopic submucosal dissection","volume":"36","author":"Hisada","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s10147-021-02112-6","article-title":"Relationship between psoas muscle index and long-term survival in older patients aged \u2265 80 years after endoscopic submucosal dissection for gastric cancer","volume":"27","author":"Ito","year":"2022","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/j.1443-1661.2010.01066.x","article-title":"Low-frequency of bacteremia after endoscopic submucosal dissection of the stomach","volume":"23","author":"Itaba","year":"2011","journal-title":"Dig. Endosc."}],"container-title":["Metabolites"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-1989\/13\/9\/969\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:40:08Z","timestamp":1760128808000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-1989\/13\/9\/969"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,23]]},"references-count":69,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["metabo13090969"],"URL":"https:\/\/doi.org\/10.3390\/metabo13090969","relation":{},"ISSN":["2218-1989"],"issn-type":[{"value":"2218-1989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,23]]}}}