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Randomized Controlled Trial
. 2016 Aug 28;22(32):7373-82.
doi: 10.3748/wjg.v22.i32.7373.

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Yuki Maeda  1 , Dai Hirasawa  1 , Naotaka Fujita  1 , Tetsuya Ohira  1 , Yoshihiro Harada  1 , Taku Yamagata  1 , Yoshiki Koike  1 , Kenjirou Suzuki  1
Affiliations
Randomized Controlled Trial

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Yuki Maeda et al. World J Gastroenterol. .

Abstract

Aim: To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema (ME) immediately after endoscopic submucosal dissection (ESD).

Methods: A total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation (CO2 group, n = 24) or air insufflation (Air group, n = 22). Computed tomography (CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale (VAS). The volume of residual gas in the digestive tract was measured using CT imaging.

Results: The incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group (17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively (P = 0.066). There were no differences in pain scores or distention scores at any post-procedure time points. The volume of residual gas in the digestive tract immediately after ESD was significantly smaller in the CO2 group than that in the Air group (808 mL vs 1173 mL, P = 0.013).

Conclusion: CO2 insufflation during esophageal ESD significantly reduced postprocedural ME. CO2 insufflation also reduced the volume of residual gas in the digestive tract immediately after ESD, but not the VAS scores of pain and distention.

Keywords: Carbon dioxide insufflation; Complication; Endoscopic submucosal dissection; Mediastinal emphysema; Superficial esophageal cancer.

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Figures

Figure 1
Figure 1
Grade of mediastinal emphysema on computed tomography[9].
Figure 2
Figure 2
Volume-rendering image of bowel gas immediately after endoscopic submucosal dissection with CO2 insufflation (A) and that of the next day (B).
Figure 3
Figure 3
Volume-rendering image of bowel gas immediately after endoscopic submucosal dissection with air insufflation (A) and that of next day (B).
Figure 4
Figure 4
Patient flow chart.
Figure 5
Figure 5
Incidence and degree of mediastinal emphysema immediately after endoscopic submucosal dissection (A) and on the day after endoscopic submucosal dissection (B). P value for the incidence of ME. Grade-0 means negative for ME. ME: Mediastinal emphysema.
Figure 6
Figure 6
Mean pain score (A) and distension score (B) on the 100-mm visual analogue scale at different time points before and after endoscopic submucosal dissection in the CO2 and Air groups. ESD: Endoscopic submucosal dissection.
See this image and copyright information in PMC

References

    1. Dellon ES, Hawk JS, Grimm IS, Shaheen NJ. The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc. 2009;69:843–849. - PubMed
    1. Sumanac K, Zealley I, Fox BM, Rawlinson J, Salena B, Marshall JK, Stevenson GW, Hunt RH. Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc. 2002;56:190–194. - PubMed
    1. Bretthauer M, Thiis-Evensen E, Huppertz-Hauss G, Gisselsson L, Grotmol T, Skovlund E, Hoff G. NORCCAP (Norwegian colorectal cancer prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy. Gut. 2002;50:604–607. - PMC - PubMed
    1. Maple JT, Keswani RN, Hovis RM, Saddedin EZ, Jonnalagadda S, Azar RR, Hagen C, Thompson DM, Waldbaum L, Edmundowicz SA. Carbon dioxide insufflation during ERCP for reduction of postprocedure pain: a randomized, double-blind, controlled trial. Gastrointest Endosc. 2009;70:278–283. - PubMed
    1. Domagk D, Bretthauer M, Lenz P, Aabakken L, Ullerich H, Maaser C, Domschke W, Kucharzik T. Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled, double-blind trial. Endoscopy. 2007;39:1064–1067. - PubMed

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