Carbon dioxide insufflation attenuates parietal blood flow obstruction in distended colon: potential advantages of carbon dioxide insufflated colonoscopy.
BACKGROUND
Bowel distention after colonoscopy has been considered as a cause of blood flow disturbance. Carbon dioxide (CO2), with its higher absorbability and vasodilating effect, may reduce parietal blood flow disturbance of distended colon when used for intraluminal insufflation instead of air. The purpose of this study was to assess parietal blood flow of the colon distended with intraluminal air/CO2 insufflation.


METHODS
A 5-cm segment of rat colon was insufflated with either air (air group) or CO2 (CO2 group). Two insufflation methods were employed: temporary insufflation up to an intraluminal pressure of 60 mmHg and continuous insufflation at a pressure of 5, 15, and 30 mmHg. Bowel distention and parietal blood flow measured by laser Doppler imaging were evaluated.


RESULTS
For temporary insufflation, bowel distention was prolonged in the air group, whereas it rapidly resolved in the CO2 group. Parietal blood flow decreased in both groups; however, it recovered within 5 min in the CO2 group. For continuous insufflation, under 5 mmHg insufflation, blood flow decreased in the air group, whereas it increased in the CO2 group. Blood flow decreased in both groups under 15 mmHg insufflation; however, it decreased less in the CO2 group. There was a reverse relationship between insufflation pressure and blood flow difference. Inhibition of nitric oxide synthase, ATP-sensitive K+ channel, or heme oxygenase was ineffective against a CO2-induced increase in blood flow.


CONCLUSIONS
CO2 insufflation preserved parietal blood flow not only by rapid resolution of bowel distention but also by its potential vasodilative effect.
Yasumasa
K
K
Department of Surgery, E1, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Nakajima
K
K
Endo
S
S
Ito
T
T
Matsuda
H
H
Nishida
T
T
D000388:Air; D000818:Animals; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000494:pharmacology; D003106:Colon / Q000098:blood supply*; D003113:Colonoscopy / Q000009:adverse effects*; D004791:Enzyme Inhibitors / Q000494:pharmacology; D005905:Glyburide / Q000494:pharmacology; D006419:Heme Oxygenase (Decyclizing) / Q000494:pharmacology; D007327:Insufflation; D008297:Male; D019331:NG-Nitroarginine Methyl Ester / Q000494:pharmacology; D026902:Potassium Channel Blockers / Q000494:pharmacology; D051381:Rats; D017207:Rats, Sprague-Dawley; D012039:Regional Blood Flow; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000494:pharmacology
D004791:Enzyme Inhibitors; D026902:Potassium Channel Blockers; D014665:Vasodilator Agents; D002245:Carbon Dioxide; D006419:Heme Oxygenase (Decyclizing); D005905:Glyburide; D019331:NG-Nitroarginine Methyl Ester