Safety and efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection  

作　　者：Jun Takada Hiroshi Araki Fumito Onogi Takayuki Nakanishi Masaya Kubota Takashi Ibuka Masahito Shimizu Hisataka Moriwaki 

机构地区：[1]Department of Gastroenterology,Gifu University Graduate School of Medicine

出　　处：《World Journal of Gastroenterology》2015年第26期8195-8202,共8页世界胃肠病学杂志（英文版）

摘　　要：AIM: To compare the safety and efficacy of carbon dioxide(CO2) and air insufflation during gastric endoscopic submucosal dissection(ESD).METHODS: This study involved 116 patients who underwent gastric ESD between January and December 2009.After eliminating 29 patients who fit the exclusion criteria,87 patients,without known pulmonary dysfunction,were randomized into the CO2 insufflation(n = 36) or air insufflation(n = 51) groups.Standard ESD was performed with a CO2 regulation unit(constant rate of 1.4 L/min) used for patients undergoing CO2 insufflation.Patients received diazepam for conscious sedation and pentazocine for analgesia.Transcutaneous CO2 tension(Ptc CO2) was recorded 15 min before,during,and after ESD with insufflation.Ptc CO2,the correlation between Ptc CO2 and procedure time,and ESD-related complications were compared between the two groups.Arterial blood gases were analyzed after ESD in the first 30 patients(12 with CO2 and 18 with air insufflation) to assess the correlation between arterial blood CO2 partial pressure(Pa CO2) and Ptc CO2.RESULTS: There were no differences in respiratoryfunctions,median sedative doses,or median procedure times between the groups.Similarly,there was no significant difference in post-ESD blood gas parameters,including Pa CO2,between the CO2 and air groups(44.6 mm Hg vs 45 mm Hg).Both groups demonstrated median p H values of 7.36,and none of the patients exhibited acidemia.No significant differences were observed between the CO2 and air groups with respect to baseline Ptc CO2(39 mm Hg vs 40 mm Hg),peak Ptc CO2 during ESD(52 mm Hg vs 51 mm Hg),or median Ptc CO2 after ESD(50 mm Hg vs 50 mm Hg).There was a strong correlation between Pa CO2 and Ptc CO2(r = 0.66; P < 0.001).The incidence of Mallory-Weiss tears was significantly lower with CO2 insufflation than with air insufflation(0% vs 15.6%,P = 0.013).CO2 insufflation did not cause any adverse events,such as CO2 narcosis or gas embolisms.CONCLUSION: CO2 insufflation during gastric ESD results in similar blood gas levelAIM: To compare the safety and efficacy of carbon dioxide(CO2) and air insufflation during gastric endoscopic submucosal dissection(ESD).METHODS: This study involved 116 patients who underwent gastric ESD between January and December 2009.After eliminating 29 patients who fit the exclusion criteria,87 patients,without known pulmonary dysfunction,were randomized into the CO2 insufflation(n = 36) or air insufflation(n = 51) groups.Standard ESD was performed with a CO2 regulation unit(constant rate of 1.4 L/min) used for patients undergoing CO2 insufflation.Patients received diazepam for conscious sedation and pentazocine for analgesia.Transcutaneous CO2 tension(Ptc CO2) was recorded 15 min before,during,and after ESD with insufflation.Ptc CO2,the correlation between Ptc CO2 and procedure time,and ESD-related complications were compared between the two groups.Arterial blood gases were analyzed after ESD in the first 30 patients(12 with CO2 and 18 with air insufflation) to assess the correlation between arterial blood CO2 partial pressure(Pa CO2) and Ptc CO2.RESULTS: There were no differences in respiratoryfunctions,median sedative doses,or median procedure times between the groups.Similarly,there was no significant difference in post-ESD blood gas parameters,including Pa CO2,between the CO2 and air groups(44.6 mm Hg vs 45 mm Hg).Both groups demonstrated median p H values of 7.36,and none of the patients exhibited acidemia.No significant differences were observed between the CO2 and air groups with respect to baseline Ptc CO2(39 mm Hg vs 40 mm Hg),peak Ptc CO2 during ESD(52 mm Hg vs 51 mm Hg),or median Ptc CO2 after ESD(50 mm Hg vs 50 mm Hg).There was a strong correlation between Pa CO2 and Ptc CO2(r = 0.66; P < 0.001).The incidence of Mallory-Weiss tears was significantly lower with CO2 insufflation than with air insufflation(0% vs 15.6%,P = 0.013).CO2 insufflation did not cause any adverse events,such as CO2 narcosis or gas embolisms.CONCLUSION: CO2 insufflation during gastric ESD results in similar blood gas level

关 键 词：Carbon dioxide GASTRIC ENDOSCOPIC submucosaldissection INSUFFLATION Mallory-Weiss TEAR Randomizedcontrolled TRIAL 

分 类 号：R735.2[医药卫生—肿瘤]