Meta‐analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy

Wang, W. L.; Wu, Zankai; Sun, Qiang; Wei, Juying; Chen, X. F.; Zhou, Dongkai; Zhou, Lei; Xie, Haiyang; Zheng, Shusen

doi:10.1111/j.1365-2036.2012.05078.x

Cited by 87 publications

(76 citation statements)

References 32 publications

(308 reference statements)

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“…This may be due to the rapid absorption of CO2 by the body compared to air. Indeed, CO2 insufflation in esophagogastroduodenoscopy efficiently reduces MWTs by lowering the tension of the gastric mucosa caused by residual gas in the stomach [32] . To our knowledge, the present study is the first RCT to demonstrate the benefit of CO2 insufflation in reducing the risk of MWTs during ESD.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection

Takada

Araki

Onogi

et al. 2015

WJG

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection

Takada

Araki

Onogi

et al. 2015

WJG

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“…Many studies evaluated the safety and efficacy of CO2 insufflation for gastrointestinal endoscopy. Two recent systematic reviews and meta-analysis showed that CO2 insufflation is safe in patients without severe pulmonary disease, and is associated with decreased bowel distension and postprocedural pain [53,54] . Furthermore, one of them showed that insufflation with CO2 in colonoscopy could also decrease abdominal pain during colonoscopy [54] .…”

Section: New Endoscopic Technologies For Colon Examinationmentioning

confidence: 99%

Colonoscopy, pain and fears: Is it an indissoluble trinomial?

Trevisani

Zelante

Sartori

2014

WJGE

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Colonoscopy is the reference method in the secondary prevention, diagnosis and, in some cases, treatment of colorectal cancer. It can often cause pain associated with embarrassment, anxiety, and physical and emotional discomfort. Pain intensity is influenced by a lot of factors, and there is a strict relationship among pain, pain perception, and mind. Several methods can be used to break the trinomial colonoscopy, pain and fear. Sedoanalgesia is recommended by several guidelines. If no sedation is offered, the patient must accept a higher chance of unacceptable discomfort and the endoscopist a lower chance of completing the procedure because of patient discomfort. Other non-pharmacologic methods such as acupuncture, music, and hydrocolonoscopy can be used as alternatives to pharmacologic sedoanalgesia. Furthermore, new endoscopic technologies such as variable-stiffness colonoscopes and ultrathin colonoscopes, or the use of carbon dioxide instead of air for colon insufflation, can reduce the pain caused by colonoscopy. In the future, technical improvements such as wireless capsules or robotic probes, will probably enable to overcome the present concept of colonoscopy, avoiding the use of traditional endoscopes. However, at present the poor attention paid by endoscopists to the pain and discomfort caused by colonoscopy can not be justified. There are several methods to reduce pain and anxiety and to break the trinomial colonoscopy, pain and fear. We must use them.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Colonoscopy; Pain; Fear; Anxiety; Discomfort; Conscious sedation Core tip: Colonoscopy can often cause pain associated with embarrassment, anxiety, and physical and emotional discomfort. Control of discomfort and pain during colonoscopy is considered to be a high priority by patients. This review of the literature encompasses the main methods for reducing pain and anxiety, to break the trinomial colonoscopy, pain and fear.

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“…CO 2 is absorbed by the bowel mucosa approximately 100 times faster than air and is rapidly eliminated through the lungs (35). This may be associated with the superior recovery quality of CO 2 insufflation compared with room air insufflation in colonoscopy (36). Therefore, when compared with air insufflation, CO 2 insufflation is expected to reduce the volume of residual gas following ESD, which is a primary cause of patient discomfort associated with this procedure, and consequently prevent the development of abdominal symptoms and problems associated with ESD (5,(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

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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Meta‐analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy

Abstract: SUMMARY BackgroundCarbon dioxide (CO 2 ) insufflation has been proposed as an alternative to air insufflation to distend the lumen in gastrointestinal (GI) endoscopy.

Cited by 87 publications

References 32 publications

Safety and efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection

Safety and efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection

Colonoscopy, pain and fears: Is it an indissoluble trinomial?

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

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