title: The usefulness and safety of carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography in elderly patients: a prospective, double-blind, randomized, controlled trial.
abstract: OBJECTIVE
  Carbon dioxide (CO2) insufflation has been used in endoscopic retrograde cholangiopancreatography (ERCP). However, its usefulness and safety are controversial in elderly patients. Our aim was to assess the safety and usefulness of CO2 insufflation during ERCP in elderly patients.
  
  
  METHODS
  Between April 2010 and June 2011, a total of 60 patients 75 years old or older, who underwent ERCP, were randomized into the CO2 group (n = 30) and the air group (n = 30). Main outcomes were determined by assessing abdominal symptoms according to the Wong-Baker FACES Pain Rating Scale, calculating the volume of residual gas retention within the intestines on abdominal X-ray quantitatively and observing the cardiopulmonary states.
  
  
  RESULTS
  30 patients in the CO2 group and 30 patients in the air group were analyzed. Abdominal distension (P < 0.01), discomfort (P < 0.01) and nausea (P < 0.01) at 2 hours after ERCP were significantly reduced in the CO2 group. The gas volume scores immediately after ERCP (P < 0.01) and at 2 hours (P < 0.01) were significantly lower in the CO2 group.
  
  
  CONCLUSIONS
  CO2 insufflation instead of air insufflation is safe and useful for the prevention of post-ERCP abdominal symptoms in elderly patients.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakamura
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Hasue
authors.forename: Kouji
authors.initials: K
authors.lastname: Higa
authors.forename: Masaru
authors.initials: M
authors.lastname: Tauchi
authors.forename: Masao
authors.initials: M
authors.lastname: Toki
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D011446:Prospective Studies
chemical_list: D002245:Carbon Dioxide