title: Efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection: a randomized, double-blind, controlled, prospective study.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is commonly performed under air insufflation and is often accompanied by abdominal discomfort. CO2 is absorbed more rapidly by the body than is air; however, the use of CO2 insufflation in ESD remains controversial. This randomized, double-blind, controlled, prospective study was designed to assess the efficacy of CO2 versus air insufflation in gastric ESD.
  
  
  METHODS
  Between May 2012 and August 2014, a total of 110 patients with gastric tumors were randomly assigned to the CO2 insufflation (CO2 group, n = 54) or air insufflation group (air group, n = 56). Abdominal pain after ESD was chronologically recorded via visual analog scale (VAS) scores. Secondary outcome measurements were adverse events, abdominal circumference, amount of sedatives prescribed, and use of analgesics.
  
  
  RESULTS
  Neither the baseline patient characteristics nor the mean procedural time differed between the groups. The VAS score for abdominal pain was 35.2 in the CO2 insufflation group versus 48.5 in the air insufflation group 1 hour after ESD (P = .026), 27.8 versus 42.5 three hours after ESD (P = .007), 18.4 versus 34.8 six hours after ESD (P = .001), and 9.2 versus 21.9 one day after ESD (P < .001). Changes in abdominal circumference, the amounts of sedative drugs taken, and the adverse events did not differ between the groups. However, the air insufflation group required more analgesics than did the CO2 insufflation group (CO2 group, 22.0% [11/50]; air group, 42.3% [22/52]; P = .028).
  
  
  CONCLUSIONS
  CO2 insufflation during gastric ESD significantly reduced abdominal pain and analgesic usage compared with air insufflation. (
  
  
  BACKGROUND
  NCT01579071.)
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Su Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Jun-Won
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Dong Kyun
authors.initials: DK
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Kwang An
authors.initials: KA
authors.lastname: Kwon
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Kyoung Oh
authors.initials: KO
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Yoon Jae
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000517:prevention & control; D000230:Adenocarcinoma / Q000601:surgery; D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide; D004210:Dissection; D004311:Double-Blind Method; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D007327:Insufflation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide