title: Efficacy of carbon dioxide versus air insufflation according to different sedation protocols during therapeutic endoscopic retrograde cholangiopancreatography: prospective, randomized, double-blind study.
abstract: OBJECTIVE
  Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) tends to require considerable air insufflation, which results in abdominal pain or distension. We investigated the efficacy of carbon dioxide (CO2 ) compared with air insufflation when using two different sedation protocols in therapeutic ERCP.
  
  
  METHODS
  Patients who required therapeutic ERCP were randomly assigned to four groups based on preliminary data: air insufflation with balanced propofol sedation (BPS), air with propofol + opioid sedation (PS), CO2 with BPS, and CO2 with PS. Post-ERCP abdominal pain, distension and nausea by the 10-point visual analogue scale (VAS), and gas volume score (GVS) by the four-point ordinal scale were measured according to the time interval. Overall satisfaction with sedation, sedation efficacy, and complications were also measured.
  
  
  RESULTS
  The CO2 with BPS group showed lowest mean VAS score for abdominal pain (immediately after recovery, P = 0.002; and 3 h post-ERCP, P = 0.047) and distension (immediately after recovery, P = 0.018; 3 h post-ERCP, P < 0.01; and 24 h post-ERCP, P = 0.042). Overall satisfaction with sedation was greater in the CO2 with BPS group (P = 0.005). Mean GVS at 2 h and 12 h post-ERCP was significantly lower in the CO2 with BPS group (P < 0.05). There were no significant differences in procedure or sedation-related complications.
  
  
  CONCLUSIONS
  CO2 with BPS showed the lowest VAS score for early abdominal pain, distension and GVS, and had a higher score for overall satisfaction for sedation.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Cheonan, Republic of Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Cheonan, Republic of Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Cheonan, Republic of Korea.
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.affiliation: Bucheon, Republic of Korea.
authors.forename: Yun Nah
authors.initials: YN
authors.lastname: Lee
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Cheonan, Republic of Korea.
authors.forename: Yunho
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Bucheon, Republic of Korea.
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Seoul, Republic of Korea.
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Cha
authors.affiliation: Bucheon, Republic of Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Seoul, Republic of Korea.
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Cheonan, Republic of Korea.
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001660:Biliary Tract Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D002245:Carbon Dioxide; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007327:Insufflation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D017060:Patient Satisfaction; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D002245:Carbon Dioxide; D015742:Propofol
keywords: ERCP; abdominal pain; air; carbon dioxide; sedation