A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation.
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 (CO(2)) insufflation during colonoscopy already has been assessed in some trials.


OBJECTIVE
To assess the safety and efficacy of CO(2) insufflation instead of air insufflation during colorectal ESD with the patient under conscious sedation.


METHODS
A case-control series with a historical control.


METHODS
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.


METHODS
Arterial partial pressure of CO(2) (pCO(2)) was measured before and after each procedure with the total dose of midazolam used as an index of abdominal discomfort.


RESULTS
The mean (standard deviation [SD]) operation time was 90 +/- 57 minutes in the CO(2) group and 100 +/- 80 minutes in the control group (not significant). In the CO(2) 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 pCO(2) elevation in the CO(2) group; however, only 2 patients complained of mild abdominal discomfort.


CONCLUSIONS
Abdominal discomfort and pCO(2) were not evaluated in the control group.


CONCLUSIONS
This study strongly suggests that CO(2) insufflation is safe and effective during lengthy colonic endoscopic procedures, eg, ESD, with the patient under conscious sedation.
Saito
Yutaka
Y
Division of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Uraoka
Toshio
T
Matsuda
Takahisa
T
Emura
Fabian
F
Ikehara
Hisatomo
H
Mashimo
Yumi
Y
Kikuchi
Tsuyoshi
T
Kozu
Takahiro
T
Saito
Daizo
D
D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000008:administration & dosage*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016292:Procedural Sedation; D006801:Humans; D007275:Injections, Intravenous; D007327:Insufflation; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008874:Midazolam / Q000008:administration & dosage; D010865:Pilot Projects; D012189:Retrospective Studies; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D002245:Carbon Dioxide; D008874:Midazolam