Carbon dioxide insufflation reduces number of postprocedure admissions after endoscopic resection of large colonic lesions: a prospective cohort study

Bassan, Milan S.; Holt, Bronte A.; Moss, Alan; Sonson, Rebecca; Bourke, Michael J.

doi:10.1016/j.gie.2012.06.004

Cited by 83 publications

(59 citation statements)

References 23 publications

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“…A recent study of air versus CO 2 insufflation for resection of large colonic lesions showed a significant reduction in the rate of postprocedure admissions due to abdominal pain with CO 2 insufflation, but no significant difference in the rates of perforation [25]. The study by Bassan et al suggested that CO 2 is rapidly absorbed into the bloodstream resulting in less bowel distention, less bowel wall tension at the mucosal resection site and hence less pain.…”

Section: Carbon Dioxide Insufflationmentioning

confidence: 99%

Endoscopic mucosal resection and endoscopic submucosal dissection of epithelial neoplasia of the colon

Kaimakliotis

Chandrasekhara²

2014

Expert Review of Gastroenterology & Hepatology

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Endoscopic mucosal resection (EMR) with curative intent has evolved into a safe and effective technique and is currently the gold standard for management of large colonic epithelial neoplasms. Piecemeal EMR is associated with a high risk of local recurrence requiring vigilant surveillance and repeat interventions. Endoscopic submucosal dissection (ESD) was introduced in Japan for the management of early gastric cancer, and has recently been described for en bloc resection of colonic lesions greater than 20 mm. En bloc resection allows accurate histological assessment of the depth of invasion, minimizes the risk of local recurrence and helps determine additional therapy. Morphologic classification of lesions prior to resection allows prediction of depth of invasion and risk of nodal metastasis, allowing selection of the appropriate intervention. This review provides an overview of the assessment of epithelial neoplasms of the colon and the application of EMR and ESD techniques in their management.

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Section: Carbon Dioxide Insufflationmentioning

confidence: 99%

Endoscopic mucosal resection and endoscopic submucosal dissection of epithelial neoplasia of the colon

Kaimakliotis

Chandrasekhara²

2014

Expert Review of Gastroenterology & Hepatology

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“…27 As such, luminal distention with CO 2 insufflation is less prolonged than with air and has been associated with less patient discomfort after longer endoscopic procedures including colonoscopy 28 and fewer postprocedure admissions in a series of patients undergoing resection of large colonic lesions. 29 The safety of CO 2 insufflation during prolonged ESD procedures under moderate and deep sedation is well-established. 30 Further, the rapid reabsorption of CO 2 may theoretically reduce the likelihood of tension pneumoperitoneum developing in the event of a perforation.…”

Section: Electrosurgical Unitsmentioning

confidence: 99%

“…[33][34][35][36][37] The rate of local recurrence generally approximates 1%, whereas 5-year overall survival ranges from 96% to 100% and 5-year disease-specific survival ranges from 99% to 100%. 29,[31][32][33] Both immediate technical outcomes (eg, R0 resection) and the local recurrence rate are superior for lesions meeting Japanese Gastric Cancer Association criteria 38 (differentiated mucosal cancer, !2 cm, without ulceration) than the expanded National Cancer Center criteria, 39 but there have been no differences in mortality. 33,[35][36][37][38][39] Two meta-analyses evaluated ESD versus EMR for the treatment of early gastric cancer.…”

Section: Efficacy and Comparison With Available Technologies Stomachmentioning

confidence: 99%

Endoscopic submucosal dissection

Maple¹,

Dayyeh²,

Chauhan³

et al. 2015

Gastrointestinal Endoscopy

220

115

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“…Most EMR resections can be performed under conscious sedation, although procedures that are anticipated to take a long time (ESD, very large PEMR) or resections close to the dentate line might be more comfortably per formed with propofol deep sedation or general anaesthe sia. Carbon dioxide insufflation is now considered as the standard of care, reducing postprocedure distention and pain 33,34 . Supplemental oxygen and an intravenous saline infusion help to maintain cardiovascular stability during the procedure and might help protect against vaso vagal reactions.…”

Section: Preparation For Emr or Esdmentioning

confidence: 99%

Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps

Saunders

Tsiamoulos

2016

Nat Rev Gastroenterol Hepatol

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Almost all large and complex colorectal polyps can now be resected endoscopically. Piecemeal endoscopic mucosal resection (PEMR) is an established technique with fairly low complication risk and good short-term and medium-term outcomes. Several modifications to the basic injection and snare technique have been developed contributing to safer and more complete resections. Delayed bleeding requiring reintervention is the most troublesome complication in 2-7% of patients, particularly in those with comorbidities and large, right-sided polyps. Endoscopic submucosal dissection (ESD) has become popular in Japan and has theoretical advantages over PEMR in providing a complete, en bloc excision for accurate histological staging and reduced local recurrence. These advantages come at the cost of a more complex, expensive and time-consuming procedure with a higher risk of perforation, particularly early in the procedure learning curve. These factors have contributed to the slow adoption of ESD in the West and the challenge to develop new devices and endoscopic platforms that will make ESD easier and safer. Currently, ESD indications are limited to large rectal lesions, in which procedural complications are easily managed, and for colorectal polyps with a high risk of containing tiny foci of early submucosally invasive cancer, whereby ESD may be curative compared with PEMR.

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Carbon dioxide insufflation reduces number of postprocedure admissions after endoscopic resection of large colonic lesions: a prospective cohort study

Cited by 83 publications

References 23 publications

Endoscopic mucosal resection and endoscopic submucosal dissection of epithelial neoplasia of the colon

Endoscopic mucosal resection and endoscopic submucosal dissection of epithelial neoplasia of the colon

Endoscopic submucosal dissection

Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps

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