A pilot study to assess mediastinal emphysema after esophageal endoscopic submucosal dissection with carbon dioxide insufflation

Maeda, Yuki; Hirasawa, Dai; Fujita, Naotaka; Obana, Takashi; Sugawara, Toshiki; Ohira, Tetsuya; Harada, Yoshihiro; Yamagata, Taku; Suzuki, Kenjiro; Koike, Yoshiki; Yamamoto, Yorimasa; Kusaka, Z.; Noda, Yutaka

doi:10.1055/s-0031-1291664

Cited by 70 publications

(51 citation statements)

References 7 publications

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“…Based on the results of a pilot study [8] , the incidence of ME with air insufflation was 63% and that of CO2 was 30%. To detect this difference with a power of 0.7 and alpha of 0.05, 22 patients per group would be required.…”

Section: Discussionmentioning

confidence: 99%

“…In several studies, CO2 insufflation during diagnostic or therapeutic endoscopy has been shown to be safe and effective in reducing procedure-related pain and discomfort [1][2][3][4][5] . The safety of CO2 insufflation for endoscopic submucosal dissection (ESD) has also been shown in several studies [6][7][8] . As for esophageal ESD, it is known that mediastinal emphysema (ME) can develop even if no perforation is recognized during or at the end of the procedure because the esophagus has no serosa [9][10][11] .…”

Section: Introductionmentioning

confidence: 94%

“…Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial after esophageal ESD with CO2 insufflation [8] . To further assess the efficacy of CO2 insufflation for reduction of post-ESD ME, we conducted a prospective, doubleblind, randomized controlled trial, the results of which are reported herein.…”

Section: Randomized Controlled Trialmentioning

confidence: 99%

“…The modes of electric power used were the 50 W autocut mode and the 50 W spray-coagulation mode [8,9] . Ten percent glycerin with 0.007% epinephrine was used for local injection into the submucosal layer.…”

Section: Procedures Of Esdmentioning

confidence: 99%

“…after esophageal ESD with CO2 insufflation [8] . To further assess the efficacy of CO2 insufflation for reduction of post-ESD ME, we conducted a prospective, doubleblind, randomized controlled trial, the results of which are reported herein.…”

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confidence: 99%

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

Maeda¹,

Hirasawa²,

Fujita³

et al. 2016

WJG

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AIMTo assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema (ME) immediately after endoscopic submucosal dissection (ESD). METHODSA 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. RESULTSThe 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 ORIGINAL ARTICLE Randomized Controlled TrialCarbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial after esophageal ESD with CO2 insufflation [8] . To further assess the efficacy of CO2 insufflation for reduction of post-ESD ME, we conducted a prospective, doubleblind, randomized controlled trial, the results of which are reported herein. MATERIALS AND METHODS Study designThis study was a single-center, randomized, doubleblind, controlled trial in Japan. This study was approved by the institutional review board of Sendai City Medical Center and met all criteria of the Declaration of Helsinki. The trial was registered with the UMIN Clinical Trials Registry (No. UMIN000006441). ParticipantsBetween February 2011 and May 2012, all consecutive patients undergoing esophageal ESD at the center were screened for recruitment. The inclusion criterion was all consecutive patients undergoing esophageal ESD. The following patients were excluded: those who had severe chronic obstructive pulmonary disease (COPD) resulting in less than 50% of the predicted values of the forced expiratory volume in 1 s (FEV1.0) or less than 70% of FEV1.0/FVC (forced vital capacity) [12] , those who had experienced CO2 retention, those who had multiple synchronous esophageal lesions treated at one time, those who were to undergo esophageal ESD under general anesthesia with positive pressure ventilation, and those who refused to participate. All participants provided written informed consent prior to enrollment in the study. Randomization and blindingParticipants were randomly assigned to either the CO2 insufflation group (CO2 group) or the air insufflation group (Air group). Randomization took place immediately before the ESD procedure. Individual randomization to the two treatment groups (1:1) was performed by using computer-generated random numbers. A sequentially numbered, opaque, sealed envelope containing a random number was opened sequentially by an endoscopy nurse after participant details were written on the envelope. When the number was even, the patient was allocated to the CO2 group and administration of CO2 was started. When the n...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Section: Randomized Controlled Trialmentioning

confidence: 99%

Section: Procedures Of Esdmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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

Maeda¹,

Hirasawa²,

Fujita³

et al. 2016

WJG

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Management of Iatrogenic Cervical Esophageal Perforations

Chen

Shapira‐Galitz

Garber

et al. 2020

JAMA Otolaryngol Head Neck Surg

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sophageal perforation is a rare but life-threatening condition that is difficult to diagnose and treat, with an incidence of 3.1 cases per 1 000 000 per year. 1 It has an overall mortality rate of 13.3%, but this percentage varies from 4% to 80% depending on the type of perforation and the time to diagnosis. 2 Discrepancies in the diagnosis and management of esophageal perforations also contribute to the wide range of mortality rates. The most common causes of esophageal perforation are iatrogenic (46.5%), spontaneous (37.8%), foreign body (6.3%), corrosive (1.8%), and traumatic (<1%). 2,3 Overall, 72.6% of esophageal perforations are thoracic, 15.2% are cervical, and 12.5% are abdominal. 2 Cervical esophageal perforations (CEPs) have a mortality rate of 6% to 8%, [4][5][6][7] which is the lowest mortality rate for esophageal perforations. However, there is little existing literature that focuses specifically on cervical perforations. A 10-year cross-sectional study 4 of CEPs found them to be due to iatrogenic injury (58%), foreign body ingestion (27%), and penetrating injury (15%). Iatrogenic CEPs (iCEPs) are unique among CEPs for various reasons. The increased frequency of endoscopy for diagnosis and treatment has led to a rising number of iatrogenic esophageal injuries. 8 In addition, the management of iCEPs is controversial and lacking in evidence. Conservative management includes antibiotics and feeding tube placement, but cervical drainage is also frequently added to this treatment regimen. More aggressive surgical approaches to treatment, such as pri-

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Management of Gastrointestinal EMR and ESD Perforation: From Lab to Practice

Thirumurthi¹,

Raju²

2015

Endoscopic Submucosal Dissection

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A pilot study to assess mediastinal emphysema after esophageal endoscopic submucosal dissection with carbon dioxide insufflation

Cited by 70 publications

References 7 publications

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

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

Management of Iatrogenic Cervical Esophageal Perforations

Management of Gastrointestinal EMR and ESD Perforation: From Lab to Practice

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