A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation

Saito, Yutaka; Uraoka, Toshio; Matsuda, Takahisa; Emura, Fabián; Ikehara, Hisatomo; Mashimo, Yumi; Kikuchi, Tsuyoshi; Kozu, Takahiro; Saito, Daizo

doi:10.1016/j.gie.2006.11.002

Cited by 192 publications

(187 citation statements)

References 36 publications

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“…It has been reported that ESD with CO2 insufflation is safe and reduces both abdominal discomfort and the risk of perforation after ESD [9,23,24] . Hereafter, ESD with CO2 insufflation should be performed during lengthy endoscopic treatment procedures to avoid complications during and after ESD.…”

Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study

Watari

Tomita²,

Toyoshima³

et al. 2013

WJGE

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AIM:To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study. METHODS:We investigated the clinical outcomes and risk factors for the development of perforation in 98 consecutive gastric neoplasms undergoing ESD regarding. Demographic and clinical parameters including patient-, tumor-, and treatment-related factors, clinical parameters, and duration of hospital stay were analyzed for risk factors for perforation. In subgroup analysis, we also compared the clinical outcomes between perforation and "silent" free air without endoscopically visible perforation detected only by computed tomography. RESULTS:Perforation was identified in 8.2% of patients. All patients were managed conservatively by the administration of antibiotics. The mean procedure time was significantly longer in patients with endoscopic perforation than in those without. According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for perforation was 115 min (87.5% sensitivity, 56.7% specificity). Prolonged procedure time (≥ 115 min) was associated with an increased risk of perforation (odds ratio 9.15; 95%CI: 1.08-77.54; P = 0.04). Following ESD, body temperature and C-reactive protein level were significantly higher in patients with perforation than in those without (P = 0.02), whereas there was no difference between these patient groups on the starting day of oral intake or of hospitalization. In subgroup analysis, the post-ESD clinical course was not different between endoscopic perforation and silent free air. CONCLUSION:Only prolonged procedure time (≥ 115 min) was significantly associated with perforation. The clinical outcomes of perforation are favorable and are comparable to those of patients with or without silent free air. Key words: Gastric cancer; Endoscopic submucosal dissection; Perforation; Risk factors; Treatment outcome Core tip: There has been little prospective study on the clinical outcomes of endoscopic perforation in endoscopic submucosal dissection for gastric neoplasia. In the current study, we investigated clinical outcomes of perforation during gastric endoscopic submucosal dissection, and analyzed various demographic and clinical parameters for risk factors. The results clearly demonstrated that prolonged procedure time (≥ 115 min),

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Section: Clinical Course In Patients With Perforationmentioning

confidence: 99%

Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study

Watari

Tomita²,

Toyoshima³

et al. 2013

WJGE

View full text Add to dashboard Cite

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“…23 In addition, carbon dioxide insufflation has been suggested to be effective during colorectal ESD. 24 Despite no definite evidence of the impact of these equipments on the ESD procedure, the diverse clinical outcomes of each study might be attributed to the various devices used in different settings.…”

Section: Discussionmentioning

confidence: 98%

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Lee

Kim

Park

et al. 2014

Korean J Gastroenterol

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Background/Aims: Endoscopic submucosal dissection (ESD) is an effective procedure for en-bloc curative resection of the colorectal tumor. As it requires high technical skills and experience in therapeutic endoscopy, it is important to understand learning curve of ESD technique. The aim of this study was to retrospectively describe the clinical results of ESD and to evaluate learning curve for the ESD of colorectal tumors. Methods: A total of 90 patients with 90 colorectal neoplasms, who had undergone ESD at a tertiary referral hospital from July 2009 to December 2012, were enrolled. The ESD was performed by a single endoscopist. All ESD cases were divided into three periods: first, cases 1-30; second, cases 31-60; and third, cases 61-90. Results: The en-bloc resection rates in third period (100%) was significantly higher than that of the first (93.3%) and second period (80%) (p=0.025). The perforation rate in third period (0%) also significantly decreased compared with that of the first (13.3%) and second period (20%) (p=0.032). To calibrate the difference of tumor size among periods, proficiency was calculated, as the procedure time per specimen area (min/cm 2 ). The proficiency in third period (4.3) was significantly shorter than that of the first (16.8) and second period (10.2) (p=0.004). Conclusions: The learning curve of colorectal ESD in our study shows that at least 60 cases of ESD have to be conducted to acquire sufficient skill of degree without perforation. (Korean J Gastroenterol 2014;64:198-205)

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“…However, one of the problems with this procedure is the severe intraoperative and post-operative abdominal discomfort and distention caused by air infusion (15). CO 2 is absorbed by the bowel mucosa approximately 100 times faster than air and is rapidly eliminated through the lungs (35).…”

Section: Discussionmentioning

confidence: 99%

“…The safety and efficacy of CO 2 insufflation during ESD for lesions of the esophagus and stomach have been demonstrated in several randomized controlled trials (15)(16)(17)(18)(19)(20)(21). A pilot study also reported that CO 2 insufflation was safe and effective during colorectal ESD (15).…”

Section: Introductionmentioning

confidence: 96%

“…A pilot study also reported that CO 2 insufflation was safe and effective during colorectal ESD (15). As CO 2 is absorbed faster than air and is rapidly eliminated through the lungs, CO 2 insufflation is expected to reduce residual gas in both the small and large bowels following ESD, and consequently reduce the abdominal symptoms and complications associated with ESD (15,(22)(23)(24)(25)(26)(27)(28)(29)(30). However, to the best of our knowledge, detailed and quantitative examinations evaluating the effects of CO 2 insufflation on residual gas in the gastrointestinal tract following colorectal ESD have not been performed.…”

Section: Introductionmentioning

confidence: 96%

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Carbon dioxide insufflation reduces residual gas in the gastrointestinal tract following colorectal endoscopic submucosal dissection

et al. 2018

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Abstract. Quantitative examinations evaluating the effects of CO 2 insufflation on residual gas in the gastrointestinal tract following colorectal endoscopic submucosal dissection (ESD) are lacking. The present study aimed to assess whether CO 2 insufflation could decrease the amount of residual gas in the gastrointestinal tract following ESD in patients with colorectal neoplasms. Computed tomography (CT) was used to objectively examine whether CO 2 insufflation during colorectal ESD reduced residual gas levels in the gastrointestinal tract following ESD. A total of 83 patients who underwent colorectal ESD between January and December 2009 at Gifu University Hospital (Gifu, Japan) were enrolled. Following exclusion of 17 patients with chronic pulmonary dysfunction, 66 patients were randomized into a CO 2 insufflation group (n=34) and an air insufflation group (n=32). The level of residual gas and the presence of transmural and free-air leaks following ESD were evaluated in both groups using CT. Transcutaneous CO 2 tension (PtcCO 2 ) and ESD-related complications were also compared between the groups. CT measurements of the major and minor axes of the cecal lumen, and of the terminal ileum diameter, indicated the level of residual gas following ESD to be significantly reduced in the CO 2 insufflation group compared with the air insufflation group (P<0.001). Neither the incidences of ESD-related complications, including post-procedure hemorrhage and air leak, nor the abnormalities in vital signs differed between the groups. No significant between-group differences were identified in the baseline and peak PtcCO 2 levels during ESD or in the median PtcCO 2 following ESD. In conclusion, CO 2 insufflation during colorectal ESD was effective in reducing residual gas in the gastrointestinal tract following ESD. IntroductionColorectal cancer is among the most prevalent malignancies worldwide, and therefore effective and minimally invasive procedures are required to reduce the incidence rate of this malignancy (1,2). More recently, utilization of colorectal endoscopic submucosal dissection (ESD) as a minimally invasive treatment for en bloc resection of large superficial neoplasms has become a favored method (3). However, the risk of complication is higher than in gastric ESD as the wall of the colon is thin and operability is limited. In addition, colorectal ESD generally requires a long procedure time due to its technical difficulty (4,5). Therefore, a high level of gas enters the colonic lumen. This is associated with aggravation of subjective symptoms, such as abdominal pain, discomfort and distention, and an increased risk of severe problems, including pneumoderma, pneumothorax, abdominal compartment syndrome and air embolism (6)(7)(8)(9)(10)(11)(12)(13)(14).The safety and efficacy of CO 2 insufflation during ESD for lesions of the esophagus and stomach have been demonstrated in several randomized controlled trials (15-21). A pilot study also reported that CO 2 insufflation was safe and effective during colorectal ES...

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A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation

Cited by 192 publications

References 36 publications

Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study

Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Carbon dioxide insufflation reduces residual gas in the gastrointestinal tract following colorectal endoscopic submucosal dissection

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