title: Safety of carbon dioxide insufflation during gastric endoscopic submucosal dissection in patients with pulmonary dysfunction under conscious sedation.
abstract: BACKGROUND
  Carbon dioxide (CO2) insufflation is effective for gastric endoscopic submucosal dissection (ESD). However, its safety is unknown in patients with pulmonary dysfunction. This study aimed to investigate the safety of CO2 insufflation during gastric ESD in patients with pulmonary dysfunction under conscious sedation.
  
  
  METHODS
  We analyzed 322 consecutive patients undergoing ESD using CO2 insufflation (1.4 L/min) for gastric lesions. Pulmonary dysfunction was defined as a forced expiratory volume in 1.0 s/forced vital capacity (FEV1.0%) <70% or vital capacity <80%. Transcutaneous partial pressure of CO2 (PtcCO2) was recorded before, during, and after ESD.
  
  
  RESULTS
  In total, 127 patients (39%) had pulmonary dysfunction. There were no significant differences in baseline PtcCO2 before ESD, peak PtcCO2 during ESD, and median PtcCO2 after ESD between the pulmonary dysfunction group and normal group. There was a significant correlation between PtcCO2 elevation from baseline and ESD procedure time (r = 0.22, P < 0.05) only in the pulmonary dysfunction group. In patients with FEV1.0% <60%, the correlation was much stronger (r = 0.39, P < 0.05). Neither the complication incidences nor the hospital stay differed between the two groups. CO2 narcosis or gas embolism was not reported in either group.
  
  
  CONCLUSIONS
  CO2 insufflation during gastric ESD in patients with pulmonary dysfunction under conscious sedation is safe with regard to complication risk and hospital stay. However, in patients with severe obstructive lung disease, especially in those with FEV1.0% <60%, longer procedure time may induce CO2 retention, thus requiring CO2 monitoring.
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan, jun_yuri1_1@yahoo.co.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Takada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Araki
authors.forename: Fumito
authors.initials: F
authors.lastname: Onogi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Masaya
authors.initials: M
authors.lastname: Kubota
authors.forename: Takashi
authors.initials: T
authors.lastname: Ibuka
authors.forename: Masahito
authors.initials: M
authors.lastname: Shimizu
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000008:administration & dosage*; D016292:Procedural Sedation / Q000379:methods*; D004210:Dissection / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008171:Lung Diseases / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014797:Vital Capacity
chemical_list: D002245:Carbon Dioxide