NORCCAP (Norwegian colorectal cancer prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy

Bretthauer, Michael; Thiis‐Evensen, Espen; Huppertz-Hauss, Gert; Gisselsson, Lennart; Grotmol, Tom; Skovlund, Eva; Hoff, Geir

doi:10.1136/gut.50.5.604

Cited by 172 publications

(204 citation statements)

References 18 publications

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“…As it appeared that there was less bloating and likely less pain after procedures using CO2 for gut distension compared to air [2] , randomized controlled trials (RCTs) were performed to compare post-procedure pain when using CO2 versus room air as the insufflation agent. The results of all of these RCTs were unambiguous, with significantly less pain reported after CO2 colonoscopy [3][4][5][6][7] . For other endoscopic procedures also, CO2 was found to be superior to air: (1) for double balloon enteroscopy, small bowel intubation is deeper [8] ; (2) for endoscopic retrograde cholangio-pancreatography (ERCP), postprocedural pain is less [9,10] ; and (3) for complex colorectal procedures (endoscopic submucosal dissection), fewer sedative drugs are required [11] .…”

Section: Introductionmentioning

confidence: 77%

Carbon dioxide for gut distension during digestive endoscopy: Technique and practice survey

Janssens¹,

Devière²,

Eisendrath³

et al. 2009

WJG

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AIM:To assess the adoption of Carbon dioxide (CO2) insufflation by endoscopists from various European countries, and its determinants. M E T H O D S :A s u r v e y w a s d i s t r i b u t e d t o 5 8 0 endoscopists attending a live course on digestive endoscopy. RESULTS:The response rate was 24.5%. Fewer than half the respondents (66/142, 46.5%) were aware of the fact that room air can be replaced by CO2 for gut distension during endoscopy, and 4.2% of respondents were actually using CO2 as the insufflation agent. Endoscopists aware of the possibility of CO2 insufflation mentioned technical difficulties in implementing the system and the absence of significant advantages of CO2 in comparison with room air as barriers to adoption in daily practice (84% and 49% of answers, respectively; two answers were permitted for this item). CONCLUSION:Based on this survey, adoption of CO2 insufflation during endoscopy seems to remain relatively exceptional. A majority of endoscopists were not aware of this possibility, while others were not aware of recent technical developments that facilitate CO2 implementation in an endoscopy suite.

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Section: Introductionmentioning

confidence: 77%

Carbon dioxide for gut distension during digestive endoscopy: Technique and practice survey

Janssens¹,

Devière²,

Eisendrath³

et al. 2009

WJG

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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%

“…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%

“…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: 99%

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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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“…Sedation is commonly used to improve patient comfort and compliance during the procedure but this has its own inherent risks and drawbacks [45]. Newer technologies such as the use of CO 2 insufflation instead of air during procedure may help to decrease patient discomfort, leading to better patient satisfaction and attendance [46].…”

Section: Colon Examinations Colonoscopymentioning

confidence: 99%

Screening for colorectal cancer: what fits best?

Lee

Leen

O’Moráin

et al. 2012

Expert Review of Gastroenterology & Hepatology

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NORCCAP (Norwegian colorectal cancer prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy

Cited by 172 publications

References 18 publications

Carbon dioxide for gut distension during digestive endoscopy: Technique and practice survey

Carbon dioxide for gut distension during digestive endoscopy: Technique and practice survey

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

Screening for colorectal cancer: what fits best?

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