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

Takada, Jun; Araki, Hiroshi; Onogi, Fumito; Nakanishi, Takayuki; Kubota, Minoru; Ibuka, Takashi; Shimizu, Masahito; Moriwaki, Hisataka

doi:10.3748/wjg.v21.i26.8195

Cited by 16 publications

(48 citation statements)

References 38 publications

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“…The factors associated with mediastinal emphysema have been reported as the exposure of the muscular layer and lesion located in the lower part of the esophagus (24), but these have not been considered regarding anesthetic methods during ESD (25). In addition, carbon dioxide (CO 2 ) has been recently used for insufflation during ESD (26). CO 2 is absorbed faster in the body than air, and it is rapidly excreted through respiration.…”

Section: Discussionmentioning

confidence: 99%

Reasonable decision of anesthesia methods in patients who underwent endoscopic submucosal dissection for superficial esophageal carcinoma: A retrospective analysis in a single Japanese institution

Kuwata¹,

Gotoda²,

Suzuki³

et al. 2016

Turk J Gastroenterol

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Section: Discussionmentioning

confidence: 99%

Reasonable decision of anesthesia methods in patients who underwent endoscopic submucosal dissection for superficial esophageal carcinoma: A retrospective analysis in a single Japanese institution

Kuwata¹,

Gotoda²,

Suzuki³

et al. 2016

Turk J Gastroenterol

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“…Takada et al [5] revealed similar levels of transcutaneous CO 2 tension and arterial blood CO 2 partial pressure during and shortly after ESD in the CO 2 group and in the air group in patients without severe pulmonary dysfunction. Maeda et al [6] revealed that CO 2 insufflation significantly reduced the volume of intestinal gas but not the visual analog scale score of abdominal pain and distension shortly after ESD compared with air insufflation.…”

Section: Equipmentmentioning

confidence: 85%

“…It was difficult to show clinical advantages of CO 2 insufflation for skillful endoscopists without perforation in two studies [5,6], but it seems to be useful for beginner endoscopists with a longer procedure time and greater possibility of perforation. Perforation itself is manageable even when air insufflation is used, and it is speculated that the possibility to lead to subsequent deteriorated status should be low when CO 2 insufflation is used [36].…”

Section: Discussionmentioning

confidence: 99%

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Updated evidence on endoscopic resection of early gastric cancer from Japan

et al. 2016

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“…Thus, we examined patients undergoing ESD while under conscious sedation and measured the levels of transcutaneous partial pressure of CO 2 (PtcCO 2 ), which is one of the most reliable parameters for estimating the partial pressure of CO 2 in arterial blood (PaCO 2 ) [31][32][33]. We also investigated the PtcCO 2 monitoring system and its potential use for determining the safety of patients during CO 2 insufflation.…”

Section: Introductionmentioning

confidence: 99%

Safety of Carbon Dioxide Insufflation during Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

Takada¹,

Araki²,

Mizutani³

et al. 2018

Dig Dis

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Background: Pulmonary dysfunction often accompanies esophageal squamous cell carcinoma (SCC). Aims: This study examined the use of carbon dioxide (CO₂) insufflation and its safety during esophageal endoscopic submucosal dissection (ESD) while under conscious sedation. Methods: ESD using CO₂ insufflation (1.4 L/min) was performed in 102 consecutive esophageal SCC patients. Patients with a forced expiratory volume of 1.0 s/forced vital capacity (FEV_1.0%) < 70% or a vital capacity < 80% were defined as having pulmonary dysfunction. Transcutaneous partial pressure of CO₂ (PtcCO₂) was recorded before, during, and after ESD. Results: A history of smoking was found in 90 patients (88%), while 43 patients (42%) had pulmonary dysfunction. No significant differences were found between the pulmonary dysfunction and normal groups for the baseline PtcCO₂ before ESD, peak PtcCO₂ during ESD, and median PtcCO₂ after ESD. There was a significant correlation between the PtcCO₂ elevation from baseline and the ESD procedure time (r = 0.32, p < 0.01), with the correlation for the pulmonary dysfunction group much stronger (r = 0.39, p < 0.05) than that for the normal group (r = 0.30, p < 0.01). Neither of the groups exhibited any differences for either the complication incidence or the hospital stay. Conclusions: Although the use of CO₂ insufflation during esophageal ESD under conscious sedation is safe with regard to the risk of complications, longer procedure times can potentially induce CO₂ retention in patients with obstructive lung disease. Thus, it is necessary to both shorten the procedure times and perform CO₂ monitoring.

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

Cited by 16 publications

References 38 publications

Reasonable decision of anesthesia methods in patients who underwent endoscopic submucosal dissection for superficial esophageal carcinoma: A retrospective analysis in a single Japanese institution

Reasonable decision of anesthesia methods in patients who underwent endoscopic submucosal dissection for superficial esophageal carcinoma: A retrospective analysis in a single Japanese institution

Updated evidence on endoscopic resection of early gastric cancer from Japan

Safety of Carbon Dioxide Insufflation during Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

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