Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial.
OBJECTIVE
To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema (ME) immediately after endoscopic submucosal dissection (ESD).


METHODS
A total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation (CO2 group, n = 24) or air insufflation (Air group, n = 22). Computed tomography (CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale (VAS). The volume of residual gas in the digestive tract was measured using CT imaging.


RESULTS
The incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group (17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively (P = 0.066). There were no differences in pain scores or distention scores at any post-procedure time points. The volume of residual gas in the digestive tract immediately after ESD was significantly smaller in the CO2 group than that in the Air group (808 mL vs 1173 mL, P = 0.013).


CONCLUSIONS
CO2 insufflation during esophageal ESD significantly reduced postprocedural ME. CO2 insufflation also reduced the volume of residual gas in the digestive tract immediately after ESD, but not the VAS scores of pain and distention.
Yuki Maeda, Dai Hirasawa, Tetsuya Ohira, Yoshihiro Harada, Taku Yamagata, Yoshiki Koike, Kenjirou Suzuki, Department of Gastroenterology, Sendai City Medical Center, Sendai 983-0824, Japan.
Yuki
Y
Maeda
Yuki Maeda, Dai Hirasawa, Tetsuya Ohira, Yoshihiro Harada, Taku Yamagata, Yoshiki Koike, Kenjirou Suzuki, Department of Gastroenterology, Sendai City Medical Center, Sendai 983-0824, Japan.
Dai
D
Hirasawa
Yuki Maeda, Dai Hirasawa, Tetsuya Ohira, Yoshihiro Harada, Taku Yamagata, Yoshiki Koike, Kenjirou Suzuki, Department of Gastroenterology, Sendai City Medical Center, Sendai 983-0824, Japan.
Naotaka
N
Fujita
Yuki Maeda, Dai Hirasawa, Tetsuya Ohira, Yoshihiro Harada, Taku Yamagata, Yoshiki Koike, Kenjirou Suzuki, Department of Gastroenterology, Sendai City Medical Center, Sendai 983-0824, Japan.
Tetsuya
T
Ohira
Yuki Maeda, Dai Hirasawa, Tetsuya Ohira, Yoshihiro Harada, Taku Yamagata, Yoshiki Koike, Kenjirou Suzuki, Department of Gastroenterology, Sendai City Medical Center, Sendai 983-0824, Japan.
Yoshihiro
Y
Harada
Yuki Maeda, Dai Hirasawa, Tetsuya Ohira, Yoshihiro Harada, Taku Yamagata, Yoshiki Koike, Kenjirou Suzuki, Department of Gastroenterology, Sendai City Medical Center, Sendai 983-0824, Japan.
Taku
T
Yamagata
Yuki Maeda, Dai Hirasawa, Tetsuya Ohira, Yoshihiro Harada, Taku Yamagata, Yoshiki Koike, Kenjirou Suzuki, Department of Gastroenterology, Sendai City Medical Center, Sendai 983-0824, Japan.
Yoshiki
Y
Koike
Yuki Maeda, Dai Hirasawa, Tetsuya Ohira, Yoshihiro Harada, Taku Yamagata, Yoshiki Koike, Kenjirou Suzuki, Department of Gastroenterology, Sendai City Medical Center, Sendai 983-0824, Japan.
Kenjirou
K
Suzuki
D000368:Aged; D002245:Carbon Dioxide / Q000008:administration & dosage; D004311:Double-Blind Method; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
D002245:Carbon Dioxide
Carbon dioxide insufflation; Complication; Endoscopic submucosal dissection; Mediastinal emphysema; Superficial esophageal cancer