title: The role of intraoperative carbon dioxide insufflating upper gastrointestinal endoscopy during laparoscopic surgery.
abstract: BACKGROUND
  Intraoperative endoscopy (IOE) is a useful adjunct during laparoscopic gastrointestinal (GI) surgery. However, one potential hazard of IOE is a prolonged bowel distension due to insufflated air, which may cause obstructed surgical exposure and increased postoperative abdominal pain. Recently, carbon dioxide (CO(2)), with its rapid absorptive nature, has been proven effective to minimize prolonged bowel distension in ambulatory/intraoperative colonoscopy. The objectives were to assess the feasibility, safety, and efficacy of CO(2)-insufflating upper GI IOE during laparoscopic surgery.
  
  
  METHODS
  A historical comparison study was performed on the initial ten consecutive patients who underwent CO(2)-insufflating upper GI IOE (CO(2)-IOE) during laparoscopic surgery. The control group consisted of the past 12 consecutive patients who underwent conventional air-insufflating upper GI IOE (air-IOE) during laparoscopic surgery. The following parameters were compared between the two groups: (1) patient demographics; (2) feasibility (% completion of IOE); (3) safety (complications related to IOE, impacts on cardiopulmonary status, including systemic blood pressure, heart rate, and end-tidal CO(2)); (4) efficacy (postoperative residual intestinal gas, time to resume oral intake, and bowel movement). The amounts of post-IOE residual intestinal gas were evaluated and classified on the immediate postoperative abdominal radiographs in a blinded manner.
  
  
  RESULTS
  Patient demographics were comparable between the two groups. IOE was completed in both groups without complications. Adverse effects on cardiopulmonary status were not observed during simultaneous intraperitoneal and intraluminal CO(2) insufflation. In the air-IOE group, one patient was converted to open surgery because of inadequate surgical exposure from prolonged distension of the downstream bowel. The patients in the CO(2)-IOE group had significantly lower grade of postoperative bowel distension than the control group. Postoperative oral intake was resumed earlier in the CO(2)-IOE group.
  
  
  CONCLUSIONS
  CO(2)-insufflating upper GI IOE during laparoscopic surgery is feasible, safe, and has a practical advantage in minimizing post-IOE bowel distension compared with conventional air-insufflating upper GI IOE.
authors.affiliation: Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Souma
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Junichi
authors.initials: J
authors.lastname: Nishimura
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Toshirou
authors.initials: T
authors.lastname: Nishida
mesh_terms: D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000008:administration & dosage*; D016022:Case-Control Studies; D016145:Endoscopy, Digestive System; D005240:Feasibility Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D007327:Insufflation / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric
chemical_list: D002245:Carbon Dioxide