Safety of carbon dioxide insufflation during gastric endoscopic submucosal dissection in patients with pulmonary dysfunction under conscious sedation

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

doi:10.1007/s00464-014-3892-0

Cited by 11 publications

(16 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, 27 patients (23.3%) who had chronic pulmonary dysfunction were excluded, as the safety of CO2 insufflation during gastric ESD has not been established for these patients. We recently reported the safety of CO2 insufflation during gastric ESD in patients with pulmonary dysfunction (FEV1.0% < 70% or %VC < 80%) under conscious sedation [35] . However, in patients with severe obstructive pulmonary disease, a longer procedure time may increase the risk of CO2 retention because there is a significant correlation between PtcCO2 elevation and ESD procedure time in patients with pulmonary dysfunction [35] .…”

Section: Discussionmentioning

confidence: 99%

“…We recently reported the safety of CO2 insufflation during gastric ESD in patients with pulmonary dysfunction (FEV1.0% < 70% or %VC < 80%) under conscious sedation [35] . However, in patients with severe obstructive pulmonary disease, a longer procedure time may increase the risk of CO2 retention because there is a significant correlation between PtcCO2 elevation and ESD procedure time in patients with pulmonary dysfunction [35] . Therefore, PtcCO2 should be carefully monitored in these patients to avoid severe complications such as CO2 narcosis and acidemia.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Takada

Araki

Onogi

et al. 2015

WJG

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Takada

Araki

Onogi

et al. 2015

WJG

Self Cite

View full text Add to dashboard Cite

“…However, a recent study demonstrated that CO 2 insufflation during gastric ESD was safe for patients with pulmonary dysfunction under conscious sedation (31). CO 2 insufflation during colorectal ESD is also safe for patients with obstructive ventilatory disturbance (41).…”

Section: Discussionmentioning

confidence: 99%

“…PtcCO 2 was continuously measured from the time of insertion of the colonoscope until the end of the procedure by using a CO 2 sensor kit (TOSCA measurement system and TOSCA 500 monitor; Linde Medical Sensors Ag, Basel, Switzerland). The low-flow gas tube (MAJ-1742, Olympus Corporation) of the UCR was used for CO 2 insufflation, which was set at a constant rate of 1.4 l/min for all patients, as reported previously (31).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2018

Self Cite

View full text Add to dashboard Cite

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...

show abstract

“…Several randomized controlled trials and prospective studies examined the use of CO 2 insufflation during ESD for lesions of the esophagus, stomach, and colorectum and reported the procedure to be both safe and efficacious [22][23][24][25]. In our previous study, we used percutaneous CO 2 monitoring and demonstrated the safety of CO 2 insufflation during gastric ESD in patients with pulmonary dysfunction under conscious sedation [26].…”

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Safety of carbon dioxide insufflation during gastric endoscopic submucosal dissection in patients with pulmonary dysfunction under conscious sedation

Cited by 11 publications

References 40 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

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

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

Contact Info

Product

Resources

About