Comparison of carbon dioxide and air insufflation use by non-expert endoscopists during endoscopic retrograde cholangiopancreatography.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is subject to several complications that include a lengthy procedure time, technical difficulty, and active bowel movement induced by air insufflation. In ERCP carried out by non-expert endoscopists who are prone to excessive luminal insufflation, insufflation with carbon dioxide (CO2 ) may provide better and safer outcomes. We aimed to assess the efficacy and safety of CO2 insufflation during ERCP by non-expert endoscopists.


METHODS
This study included 208 consecutive patients who received ERCP, excluding those in poor general health or with obstructive lung disease. The first operator for each patient was a non-expert endoscopist having done 50 or fewer ERCP procedures. Primary outcomes were the changes in cardiopulmonary state during ERCP. Secondary outcomes were ERCP complications. We designed a single-center, randomized, prospective, double-blind, controlled trial with CO2 and air insufflation during ERCP.


RESULTS
CO2 insufflation did not affect overall procedure progression or results. A positive correlation was observed between procedure time and change in maximal systolic blood pressure from baseline among patients in the air insufflation group, but not in the CO2 insufflation group (correlation coefficient 0.408 vs 0.114, change in the maximal systolic blood pressure from baseline +4.2 vs+1.2 mmHg/10 min). This was consistent with our findings in patients treated by the first operator alone. The occurrence rate of post-ERCP pancreatitis tended to be lower in the CO2 group than the air group (4/102 [3.9%]vs 0/106 [0%], P = 0.056).


CONCLUSIONS
CO2 insufflation during ERCP by non-expert endoscopists is recommended from the standpoints of efficacy and safety.
Department of Medicine, Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan. muraki@shinshu-u.ac.jp
Takashi
T
Muraki
Norikazu
N
Arakura
Ryou
R
Kodama
Suguru
S
Yoneda
Masafumi
M
Maruyama
Tetsuya
T
Itou
Takayuki
T
Watanabe
Masahiro
M
Maruyama
Akihiro
A
Matsumoto
Shigeyuki
S
Kawa
Eiji
E
Tanaka
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D002245:Carbon Dioxide; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002983:Clinical Competence; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology; D011446:Prospective Studies
D002245:Carbon Dioxide