A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation

• Published in: Gastrointestinal endoscopy Vol. 65; no. 3; pp. 537 - 542
• Main Authors: Saito, Yutaka, MD, PhD, Uraoka, Toshio, MD, PhD, Matsuda, Takahisa, MD, Emura, Fabian, MD, PhD, Ikehara, Hisatomo, MD, Mashimo, Yumi, MD, PhD, Kikuchi, Tsuyoshi, MD, Kozu, Takahiro, MD, Saito, Daizo, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.2007; Elsevier
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous - administration & dosage; Biological and medical sciences; Carbon Dioxide - administration & dosage; Colonoscopy - methods; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Conscious Sedation; Digestive system. Abdomen; Endoscopy; Gastroenterology and Hepatology; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Injections, Intravenous; Insufflation; Intestinal Mucosa - pathology; Intestinal Mucosa - surgery; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Midazolam - administration & dosage; Pilot Projects; Retrospective Studies; Treatment Outcome; Human; Psychotropic; Toxicity; Carbon dioxide; Hypnotic; Sedation; Abdomen; Treatment; Colonoscopy; Rectum; Benzodiazepine derivatives; Arterial pressure; Submucosa; Colon; Endoscopy; Midazolam; Sedative
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2006.11.002

Background Endoscopic submucosal dissection (ESD) is accepted as one of the treatments for en bloc resection of large superficial colorectal lesions. This procedure is performed by using air insufflation, is time consuming, and is associated with severe abdominal discomfort. The safety and efficacy of carbon dioxide (CO2 ) insufflation during colonoscopy already has been assessed in some trials. Objective To assess the safety and efficacy of CO2 insufflation instead of air insufflation during colorectal ESD with the patient under conscious sedation. Design A case-control series with a historical control. Patients A total of 35 consecutive patients were enrolled in this study. Another 35 consecutive patients who previously received colorectal ESDs by using air insufflation were included as a historical control. Interventions Arterial partial pressure of CO2 (pCO2 ) was measured before and after each procedure with the total dose of midazolam used as an index of abdominal discomfort. Main Outcome Measurements and Results The mean (standard deviation [SD]) operation time was 90 ± 57 minutes in the CO2 group and 100 ± 80 minutes in the control group (not significant). In the CO2 group, the mean (SD) dose of midazolam was significantly lower than that of the control group; 5.6 ± 4.9 mg and 9.7 ± 5.9 mg, respectively ( P = .005). Blood analysis revealed a slight pCO2 elevation in the CO2 group; however, only 2 patients complained of mild abdominal discomfort. Limitations Abdominal discomfort and pCO2 were not evaluated in the control group. Conclusions This study strongly suggests that CO2 insufflation is safe and effective during lengthy colonic endoscopic procedures, eg, ESD, with the patient under conscious sedation.