title: Inhibitory effects of carbon dioxide insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy.
abstract: OBJECTIVE
  To evaluate the inhibitory effects of carbon dioxide (CO(2)) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).
  
  
  METHODS
  A total of 73 consecutive patients who were undergoing PEG were enrolled in our study. After eliminating 13 patients who fitted our exclusion criteria, 60 patients were randomly assigned to either CO(2) (30 patients) or air insufflation (30 patients) groups. PEG was performed by pull-through technique after three-point fixation of the gastric wall to the abdominal wall using a gastropexy device. Arterial blood gas analysis was performed immediately before and after the procedure. Abdominal X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel distension. Abdominal computed tomography was performed at 24 h after the procedure to detect the presence of pneumoperitoneum. The outcomes of PEG for 7 d post-procedure were also investigated.
  
  
  RESULTS
  Among 30 patients each for the air and the CO(2) groups, PEG could not be conducted in 2 patients of the CO(2) group, thus they were excluded. Analyses of the remaining 58 patients showed that the patients' backgrounds were not significantly different between the two groups. The elevation values of arterial partial pressure of CO(2) in the air group and the CO(2) group were 2.67 mmHg and 3.32 mmHg, respectively (P = 0.408). The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO(2) group compared to the air group (P < 0.001) at 10 min and 24 h after PEG, whereas there was no significant difference in large bowel distension between the two groups. Pneumoperitoneum was observed only in the air group but not in the CO(2) group (P = 0.003). There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two groups.
  
  
  CONCLUSIONS
  There was no adverse event associated with CO(2) insufflation. CO(2) insufflation is considered to be safer and more comfortable for PEG patients because of the lower incidence of pneumoperitoneum and less distension of the small bowel.
authors: Department of Internal Medicine, Nishimino Kosei Hospital, Gifu 503-1394, Japan. wakky@nishimino.gfkosei.or.jp
authors: Shinji
authors: S
authors: Nishiwaki
authors: Hiroshi
authors: H
authors: Araki
authors: Motoshi
authors: M
authors: Hayashi
authors: Jun
authors: J
authors: Takada
authors: Masahide
authors: M
authors: Iwashita
authors: Atsushi
authors: A
authors: Tagami
authors: Hiroo
authors: H
authors: Hatakeyama
authors: Takao
authors: T
authors: Hayashi
authors: Teruo
authors: T
authors: Maeda
authors: Koshiro
authors: K
authors: Saito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000009:adverse effects; D004108:Dilatation, Pathologic; D005260:Female; D005740:Gases; D005773:Gastroscopy / Q000009:adverse effects*; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007327:Insufflation / Q000009:adverse effects; D007422:Intestines / Q000473:pathology*; D007564:Japan; D008297:Male; D011027:Pneumoperitoneum / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005740:Gases; D002245:Carbon Dioxide