Inhibitory effects of carbon dioxide insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy

Abstract

There was no adverse event associated with CO(2) insufflation. CO(2) insufflation is considered to be safer and more comfortable for PEG patients because of the lower incidence of pneumoperitoneum and less distension of the small bowel.

Insufflation with carbon dioxide reduces pneumoperitoneum after percutaneous endoscopic gastrostomy (PEG): a randomized controlled trial

“…Our study is the second report to evaluate CO 2 insufflation during PEG and confirms previous results demonstrating that CO 2 use significantly reduces the rate of post-PEG pneumoperitoneum 7 . Our rate of capnoperitoneum was 14.3 %, substantially higher than the previous study of 58 patients, which reported a rate of 0 %.…”

“…Abdominal computed tomography (CT), the most sensitive imaging modality for identifying intraperitoneal free air, was used in two studies. One series obtaining CT 24 hours after PEG reported a rate of 26.7 %, however, as previously noted, this study used gastropexy 7 . In the second series, in which abdominal CT scans were obtained from 1 hour to 9 days after gastrostomy, the rate was 56 %, but this study was performed by Interventional Radiology under push-technique with dilators, which likely increased the incidence of pneumoperitoneum 5 .…”

“…Incidence of post-PEG pneumoperitoneum using ambient air varies widely in published reports (8.6 %-56 %) 4 5 6 7 . This is likely due to numerous differences in study design, including timing and sensitivity of imaging modalities and differences in gastrostomy technique.…”

“…The procedure is highly successful with a low overall rate of serious complications 2 . Pneumoperitoneum is relatively common after PEG, reported in 8.6 % to 56 % of cases, and usually self-limited, however, it may be associated with post-procedural bloating, discomfort, and pain 3 4 5 6 7 . Air is thought to leak into the peritoneum from full insufflation of the stomach during the between trochar needle insertion and final positioning of the gastrostomy tube 6 .…”

“…The only previous study evaluating the role of CO 2 insufflation during PEG placement used placement of multiple gastropexies prior to standard pull-through technique 7 . In that study, CO 2 compared to ambient air was associated with less frequent post-procedural pneumoperitoneum and a reduction in small bowel distention, but pain and discomfort were not evaluated.…”