title: Carbon dioxide insufflation is useful for obtaining clear images of the bile duct during peroral cholangioscopy (with video).
abstract: BACKGROUND
  Peroral cholangioscopy (POCS) is useful for the diagnosis of various bile duct lesions. However, it is often difficult to obtain clear images because of bile or biliary sludge in the bile duct, even after vigorous irrigation of the bile duct with saline solution. Therefore, this study investigated whether inflation with carbon dioxide (CO(2)) yields clearer images of the bile duct than conventional saline solution irrigation during POCS.
  
  
  OBJECTIVE
  To evaluate the clinical utility and safety of CO(2) insufflation into the bile duct to obtain clear images in POCS observations by comparing this method with conventional saline solution irrigation.
  
  
  METHODS
  A single center.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Nineteen patients with suspected biliary diseases.
  
  
  METHODS
  CO(2) insufflation into the bile duct during POCS.
  
  
  METHODS
  The quality and safety of this method.
  
  
  RESULTS
  The quality of the images of the bile duct lumen with CO(2) insufflation (10 patients) was significantly superior to those with saline solution irrigation (9 patients) in both clarity (P < .05) and color (P < .05). In particular, extremely clear images could be obtained from the middle part of common bile duct to the right and left hepatic duct. No serious POCS-related complications occurred. There was no significant change in the venous partial pressure of the CO(2) level during the procedure.
  
  
  CONCLUSIONS
  The number of patients examined was small.
  
  
  CONCLUSIONS
  CO(2) insufflation is useful for obtaining clear images of the bile duct during POCS, which makes it possible to determine the qualitative diagnosis and the extent of various bile duct lesions.
authors.affiliation: Department of Internal Medicine, Fukuyama City Hosptial, Japan. torueki0730@yahoo.co.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Ueki
authors.forename: Motowo
authors.initials: M
authors.lastname: Mizuno
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ota
authors.forename: Tsuneyoshi
authors.initials: T
authors.lastname: Ogawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsushita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Uchida
authors.forename: Norifumi
authors.initials: N
authors.lastname: Numata
authors.forename: Asuka
authors.initials: A
authors.lastname: Ueda
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kominami
authors.forename: Shintaro
authors.initials: S
authors.lastname: Nanba
authors.forename: Manabu
authors.initials: M
authors.lastname: Kurome
authors.forename: Hirotoki
authors.initials: H
authors.lastname: Ohe
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Araki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017734:Bile Ducts, Extrahepatic; D001660:Biliary Tract Diseases / Q000175:diagnosis*; D002245:Carbon Dioxide; D016022:Case-Control Studies; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D007507:Therapeutic Irrigation; D014741:Video Recording
chemical_list: D002245:Carbon Dioxide