Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled, double-blind trial

Domagk, Dirk; Bretthauer, Michael; Lenz, Philipp; Aabakken, Lars; Ullerich, Hansjoerg; Domschke, Wolfram; Kucharzik, Torsten

doi:10.1055/s-2007-966990

Cited by 113 publications

(128 citation statements)

References 14 publications

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“…The usefulness and safety of CO2 as an alternative to air in patients who undergo diagnostic or therapeutic endoscopy under conscious or intravenously sedated conditions have been demonstrated in several randomized controlled studies [1][2][3][4][5][6] . No pulmonary complications or CO2 retention have reportedly occurred from CO2 insufflation in patients without some type of pulmonary dysfunction, and no adverse event related to CO2 insufflation developed in the present study either.…”

Section: Discussionmentioning

confidence: 99%

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Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Maeda¹,

Hirasawa²,

Fujita³

et al. 2016

WJG

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AIMTo assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema (ME) immediately after endoscopic submucosal dissection (ESD). METHODSA total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation (CO2 group, n = 24) or air insufflation (Air group, n = 22). Computed tomography (CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale (VAS). The volume of residual gas in the digestive tract was measured using CT imaging. RESULTSThe incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group (17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively (P ORIGINAL ARTICLE Randomized Controlled TrialCarbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial after esophageal ESD with CO2 insufflation [8] . To further assess the efficacy of CO2 insufflation for reduction of post-ESD ME, we conducted a prospective, doubleblind, randomized controlled trial, the results of which are reported herein. MATERIALS AND METHODS Study designThis study was a single-center, randomized, doubleblind, controlled trial in Japan. This study was approved by the institutional review board of Sendai City Medical Center and met all criteria of the Declaration of Helsinki. The trial was registered with the UMIN Clinical Trials Registry (No. UMIN000006441). ParticipantsBetween February 2011 and May 2012, all consecutive patients undergoing esophageal ESD at the center were screened for recruitment. The inclusion criterion was all consecutive patients undergoing esophageal ESD. The following patients were excluded: those who had severe chronic obstructive pulmonary disease (COPD) resulting in less than 50% of the predicted values of the forced expiratory volume in 1 s (FEV1.0) or less than 70% of FEV1.0/FVC (forced vital capacity) [12] , those who had experienced CO2 retention, those who had multiple synchronous esophageal lesions treated at one time, those who were to undergo esophageal ESD under general anesthesia with positive pressure ventilation, and those who refused to participate. All participants provided written informed consent prior to enrollment in the study. Randomization and blindingParticipants were randomly assigned to either the CO2 insufflation group (CO2 group) or the air insufflation group (Air group). Randomization took place immediately before the ESD procedure. Individual randomization to the two treatment groups (1:1) was performed by using computer-generated random numbers. A sequentially numbered, opaque, sealed envelope containing a random number was opened sequentially by an endoscopy nurse after participant details were written on the envelope. When the number was even, the patient was allocated to the CO2 group and administration of CO2 was started. When the n...

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Section: Discussionmentioning

confidence: 99%

“…In several studies, CO2 insufflation during diagnostic or therapeutic endoscopy has been shown to be safe and effective in reducing procedure-related pain and discomfort [1][2][3][4][5] . The safety of CO2 insufflation for endoscopic submucosal dissection (ESD) has also been shown in several studies [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Maeda¹,

Hirasawa²,

Fujita³

et al. 2016

WJG

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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

jig

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“…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] . This is explained by the pathophysiology of gases: intestinal gases leave the body through alimentary orifices and exhaled air (gases can diffuse through the gut into splanchnic blood and subsequently pulmonary circulation).…”

Section: Introductionmentioning

confidence: 99%

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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Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled, double-blind trial

Abstract: CO (2) insufflation significantly extended intubation depth in DBE. CO (2) insufflation also reduces patient discomfort. CO (2) insufflation may lead to a higher diagnostic and therapeutic yield of DBE, with reduced patient discomfort.

Cited by 113 publications

References 14 publications

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial

Interventional balloon-enteroscopy

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

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