Effects of carbon dioxide insufflation in esophageal endoscopic submucosal dissection.
OBJECTIVE
Although carbon dioxide (CO2) insufflation has successfully replaced air insufflation in a variety of procedures, the effects of CO2-insufflation in esophageal endoscopic submucosal dissection (ESD) have not been adequately investigated. This study was designed to evaluate the effects of CO2 insufflation in esophageal ESD.


METHODS
From January 2009 to January 2011, 57 superficial esophageal neoplasias in 54 patients (51 men and 3 women) were treated under conscious sedation with midazolam and pethidine hydrochloride, using ESD technique with a combination of small-caliber-tip transparent hood and flex knife. They were divided into air-insufflation (39 lesions, 37 patients) and CO2-insufflation (18 lesions, 17 patients) groups and therapeutic efficacy and complications were retrospectively evaluated in each group.


RESULTS
The rate of en bloc resection was 100% and there were no complications in each group. No significant differences were seen in procedural time, the amount of pethidine hydrochloride required, body temperature and white blood cell count on post-procedure day 1, and length of hospital stay after ESD. A difference in the amount of midazolam required between the air-insufflation group and the CO2-insufflation group was noted (6mg vs. 4mg, p=0.0017).


CONCLUSIONS
CO2-insufflation could be considered useful for reducing patients' discomfort in esophageal ESD.
Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
Masayo
M
Uemura
Naoki
N
Ishii
Toshiyuki
T
Itoh
Koyu
K
Suzuki
Yoshiyuki
Y
Fujita
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002245:Carbon Dioxide; D016292:Procedural Sedation; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007327:Insufflation / Q000009:adverse effects / Q000379:methods*; D007564:Japan; D007902:Length of Stay; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D002245:Carbon Dioxide; D008614:Meperidine; D008874:Midazolam