Document Detail

A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation.
MedLine Citation:
PMID:  17321264     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Endoscopic submucosal dissection (ESD) is accepted as one of the treatments for en bloc resection of large superficial colorectal lesions. This procedure is performed by using air insufflation, is time consuming, and is associated with severe abdominal discomfort. The safety and efficacy of carbon dioxide (CO(2)) insufflation during colonoscopy already has been assessed in some trials.
OBJECTIVE: To assess the safety and efficacy of CO(2) insufflation instead of air insufflation during colorectal ESD with the patient under conscious sedation.
DESIGN: A case-control series with a historical control.
PATIENTS: A total of 35 consecutive patients were enrolled in this study. Another 35 consecutive patients who previously received colorectal ESDs by using air insufflation were included as a historical control.
INTERVENTIONS: Arterial partial pressure of CO(2) (pCO(2)) was measured before and after each procedure with the total dose of midazolam used as an index of abdominal discomfort.
MAIN OUTCOME MEASUREMENTS AND RESULTS: The mean (standard deviation [SD]) operation time was 90 +/- 57 minutes in the CO(2) group and 100 +/- 80 minutes in the control group (not significant). In the CO(2) group, the mean (SD) dose of midazolam was significantly lower than that of the control group; 5.6 +/- 4.9 mg and 9.7 +/- 5.9 mg, respectively (P = .005). Blood analysis revealed a slight pCO(2) elevation in the CO(2) group; however, only 2 patients complained of mild abdominal discomfort.
LIMITATIONS: Abdominal discomfort and pCO(2) were not evaluated in the control group.
CONCLUSIONS: This study strongly suggests that CO(2) insufflation is safe and effective during lengthy colonic endoscopic procedures, eg, ESD, with the patient under conscious sedation.
Yutaka Saito; Toshio Uraoka; Takahisa Matsuda; Fabian Emura; Hisatomo Ikehara; Yumi Mashimo; Tsuyoshi Kikuchi; Takahiro Kozu; Daizo Saito
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  65     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-26     Completed Date:  2007-04-05     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  537-42     Citation Subset:  IM    
Division of Endoscopy, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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MeSH Terms
Anesthetics, Intravenous / administration & dosage
Carbon Dioxide / administration & dosage*
Colonoscopy / methods*
Colorectal Neoplasms / pathology,  surgery*
Conscious Sedation*
Injections, Intravenous
Intestinal Mucosa / pathology,  surgery*
Midazolam / administration & dosage
Pilot Projects
Retrospective Studies
Treatment Outcome
Reg. No./Substance:
0/Anesthetics, Intravenous; 124-38-9/Carbon Dioxide; 59467-70-8/Midazolam

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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