Carbon dioxide insufflation compared with air insufflation in double-balloon enteroscopy: a prospective, randomized, double-blind trial

Hirai, Fumihito; Beppu, Takahiro; Nishimura, Taku; Takatsu, Noritaka; Ashizuka, Shinya; Seki, Tsunetake; Hisabe, Takashi; Nishizaki, Takashi; Yao, Kenshi; Matsui, Toshiyuki; Beppu, Tsuyoshi; Nakashima, Rikiya; Inada, Naomi; Tajiri, Eriko; Mitsuru, Hideko; Shigematsu, Hideko

doi:10.1016/j.gie.2010.10.003

Cited by 59 publications

(80 citation statements)

References 12 publications

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“…Carbon dioxide insufflation instead of using ambient air increases intubation depth and significantly reduces inconvenience of the patient and may therefore be preferred for all balloon-enteroscopy interventions. 8,9 In comparison to spiral enteroscopy, the examination time was reduced with use of the spiral, although the insertion depth with DBE was superior.…”

Section: Introductionmentioning

confidence: 99%

Interventional balloon-enteroscopy

Albert¹

2012

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Section: Introductionmentioning

confidence: 99%

Interventional balloon-enteroscopy

Albert¹

2012

jig

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“…procedures (24,25,28,37,38). However, few studies have objectively evaluated the level of residual bowel gas following this procedure.…”

Section: Discussionmentioning

confidence: 99%

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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“…Hirai et al 6 performed arterial blood gas analysis, and Li et al 8 recorded end-tidal CO 2 after balloon-assisted Figure 2. Forest plot displaying the weighted mean difference (WMD) and 95% confidence intervals (95% CIs) of each study for the intubation depth of oral enteroscopy.…”

Section: Co 2 Retentionmentioning

confidence: 99%

“…5 However, other studies produced inconsistent results. [6][7][8] The number of patients enrolled in some trials has been too few to achieve statistically conclusive results. We proposed that systematically pooling data from all published reports might provide a better understanding of the efficacy of CO 2 insufflation for balloon-assisted enteroscopy.…”

Section: Introductionmentioning

confidence: 99%

Effects of carbon dioxide insufflation in balloon‐assisted enteroscopy: A systematic review and meta‐analysis

et al. 2016

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Background and aim: The efficacy of CO 2 insufflation during balloon-assisted enteroscopy remains controversial. This study aimed to perform a systematic review with meta-analysis of randomized controlled trials (RCTs) in which CO 2 insufflation was compared with air insufflation in balloon-assisted enteroscopy. Methods: PubMed, the Cochrane library, and the Igaku-Chuo-Zasshi database were searched to identify RCTs eligible for inclusion in the systematic review. Data from the eligible studies were combined to calculate the pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs). Results: Four RCTs (461 patients) were identified. Compared with air insufflation, CO 2 insufflation significantly increased intubation depth of oral enteroscopy (WMD: 55.2, 95% CI: 10.77-99.65, p ¼ 0.015). However, there was significant heterogeneity. The intubation depth of anal enteroscopy showed no significant difference between the CO 2 group and the air group. CO 2 insufflation significantly reduced abdominal pain compared with air insufflation (WMD: À2.463, 95% CI: À4.452 to À0.474, p ¼ 0.015), without significant heterogeneity. The PaCO 2 or end-tidal CO 2 level showed no significant difference between the CO 2 group and air group. Conclusions: Compared with air insufflation, CO 2 insufflation during balloon-assisted enteroscopy caused less postprocedural pain without CO 2 retention.

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Carbon dioxide insufflation compared with air insufflation in double-balloon enteroscopy: a prospective, randomized, double-blind trial

Cited by 59 publications

References 12 publications

Interventional balloon-enteroscopy

Interventional balloon-enteroscopy

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

Effects of carbon dioxide insufflation in balloon‐assisted enteroscopy: A systematic review and meta‐analysis

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