Skip to main content

Advertisement

SpringerLink
Log in

Safety of carbon dioxide insufflation for upper gastrointestinal tract endoscopic treatment of patients under deep sedation

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

It is well known that carbon dioxide (CO2) is absorbed faster in the body than air and also that it is rapidly excreted through respiration. This study aimed to investigate the safety of CO2 insufflation used for esophageal and gastric endoscopic submucosal dissection (ESD) in patients under deep sedation.

Methods

Patients with either early gastric or esophageal cancers that could be resected by ESD were enrolled in this study from March 2007 to July 2008 and randomly assigned to undergo ESD procedures with CO2 insufflation (CO2 group) or air insufflation (air group). A TOSCA measurement system and TOSCA 500 monitor were used to measure and monitor both transcutaneous partial pressure of CO2 (PtcCO2) and oxygen saturation (SpO2).

Results

The study enrolled 89 patients and randomly assigned them to a CO2 group (45 patients) or an air group (44 patients). The mean CO2 group versus air group measurements were as follows: PtcCO2 (49.1 ± 5.0 vs. 50.1 ± 5.3 mmHg; nonsignificant difference [NS]), maximum PtcCO2 (55.1 ± 6.5 vs. 56.8 ± 7.0 mmHg; NS), PtcCO2 elevation (9.1 ± 5.4 vs. 11.4 ± 5.6 mmHg; p = 0.054), SpO2 (99.0 ± 0.7% vs. 99.0 ± 1.0%; NS), minimum SpO2 (96.5 ± 2.4% vs. 95.4 ± 3.3%; p = 0.085), and SpO2 depression (2.4 ± 2.3% vs. 3.3 ± 2.9%; NS). The PtcCO2 and SpO2 measurements were similar in the two groups, but the CO2 group was better than the air group in PtcCO2 elevation and minimum SpO2.

Conclusions

The findings demonstrated CO2 insufflation to be as safe as air insufflation for upper gastrointestinal tract ESDs performed for patients under deep sedation without evidencing any adverse effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hussein AM, Bartram CI, Williams CB (1984) Carbon dioxide insufflation for more comfortable colonoscopy. Gastrointest Endosc 30:68–70

    Article  CAS  PubMed  Google Scholar 

  2. Stevenson GW, Wilson JA, Wilkinson J, Norman G, Goodacre RL (1992) Pain following colonoscopy: elimination with carbon dioxide. Gastrointest Endosc 38:564–567

    Article  CAS  PubMed  Google Scholar 

  3. Church J, Delaney C (2003) Randomized, controlled trial of carbon dioxide insufflation during colonoscopy. Dis Colon Rectum 46:322–326

    Article  CAS  PubMed  Google Scholar 

  4. Bretthauer M, Thiis-Evensen E, Huppertz-Hauss G, Gisselsson L, Grotmol T, Skovlund E, Hoff G (2002) NORCCAP (Norwegian colorectal cancer prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy. Gut 50:604–607

    Article  CAS  PubMed  Google Scholar 

  5. Bretthauer M, Lynge AB, Thiis-Evensen E, Hoff G, Fausa O, Aabakken L (2005) Carbon dioxide insufflation in colonoscopy: safe and effective in sedated patients. Endoscopy 37:706–709

    Article  CAS  PubMed  Google Scholar 

  6. Bretthauer M, Seip B, Aasen S, Kordal M, Hoff G, Aabakken L (2007) Carbon dioxide insufflation for more comfortable endoscopic retrograde cholangiopancreatography: a randomized, controlled, double-blind trial. Endoscopy 39:58–64

    Article  CAS  PubMed  Google Scholar 

  7. Minami S, Gotoda T, Ono H, Oda I, Hamanaka H (2006) Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc 63:596–601

    Article  PubMed  Google Scholar 

  8. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy 38:1001–1006

    Article  CAS  PubMed  Google Scholar 

  9. Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, Miyata Y (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3:67–70

    Article  Google Scholar 

  10. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 4:688–694

    Article  PubMed  Google Scholar 

  11. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  CAS  PubMed  Google Scholar 

  12. Yamamoto H, Kawata H, Sunada K, Sasaki A, Nakazawa K, Miyata T, Sekine Y, Yano T, Satoh K, Ido K, Sugano K (2003) Successful en bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 35:690–694

    Article  CAS  PubMed  Google Scholar 

  13. Yahagi N, Fujishiro M, Kakushima N, Kobayashi K, Hashimoto T, Oka M (2004) Endoscopic submucosal dissection for early gastric cancer using the tip of an electrosurgical snare (thin type). Dig Endosc 16:34–38

    Article  Google Scholar 

  14. Oda I, Gotoda T, Hamanaka H (2005) Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time, and complications from a large consecutive series. Dig Endosc 17:54–58

    Article  Google Scholar 

  15. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Fu KI, Sano Y, Saito D (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 66:966–973

    Article  PubMed  Google Scholar 

  16. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2007) Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 5:678–683

    Article  PubMed  Google Scholar 

  17. Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11

    Article  PubMed  Google Scholar 

  18. Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, Saito D, Ono H (2008) Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection: an analysis of risk factors. Endoscopy 40:179–183

    Article  CAS  PubMed  Google Scholar 

  19. Kimball EJ, Rollins MD, Mone MC, Hansen HJ, Baraghoshi GK, Johnston C, Day ES, Jackson PR, Payne M, Barton RG (2006) Survey of intensive care physicians on the recognition and management of intraabdominal hypertension and abdominal compartment syndrome. Crit Care Med 34:2340–2348

    Article  PubMed  Google Scholar 

  20. Williams C (1986) Who’s for CO2? Gastrointest Endosc 32:365–367

    Article  CAS  PubMed  Google Scholar 

  21. Hayakawa M, Gando S, Kameue T, Morimoto Y, Kemmotsu O (2002) Abdominal compartment syndrome and intrahepatic portal venous gas: a possible complication of endoscopy. Intensive Care Med 28:1680–1681

    Article  PubMed  Google Scholar 

  22. Peppriell JE, Bacon DR (2000) Acute abdominal compartment syndrome with pulseless electrical activity during colonoscopy with conscious sedation. J Clin Anesth 12:216–219

    Article  CAS  PubMed  Google Scholar 

  23. Rizzo AG, Sample GA (2003) Thoracic compartment syndrome secondary to a thoracic procedure: a case report. Chest 124:1164–1168

    Article  PubMed  Google Scholar 

  24. van Mook WN, Huslewe-Evers RP, Ramsay G (2002) Abdominal compartment syndrome. Lancet 360:1502

    Article  PubMed  Google Scholar 

  25. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Kozu T, Saito D (2007) A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. Gastrointest Endosc 65:537–542

    Article  PubMed  Google Scholar 

  26. Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, Yokota T (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50:560–563

    Article  CAS  PubMed  Google Scholar 

  27. Ono H, Hasuike N, Inui T, Takizawa K, Ikehara H, Yamaguchi Y, Otake Y, Matsubayashi H (2008) Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer. Gastric Cancer 11:47–52

    Article  PubMed  Google Scholar 

  28. Saito Y, Takisawa H, Suzuki H, Takizawa K, Yokoi C, Nonaka S, Matsuda T, Nakanishi Y, Kato K (2008) Endoscopic submucosal dissection of recurrent or residual superficial esophageal cancer after chemoradiotherapy. Gastrointest Endosc 67:355–359

    Article  PubMed  Google Scholar 

  29. Yamamoto H, Yahagi N, Oyama T, Gotoda T, Doi T, Hirasaki S, Shimoda T, Sugano K, Tajiri H, Takekoshi T, Saito D (2008) Usefulness and safety of 0.4% sodium hyaluronate solution as a submucosal fluid “cushion” in endoscopic resection for gastric neoplasms: a prospective multicenter trial. Gastrointest Endosc 67:830–839

    Article  PubMed  Google Scholar 

  30. Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Enomoto S, Kakushima N, Kobayashi K, Hashimoto T, Iguchi M, Shimizu Y, Ichinose M, Omata M (2004) Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy 36:579–583

    Article  CAS  PubMed  Google Scholar 

  31. Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Matsuura T, Enomoto S, Kakushima N, Imagawa A, Kobayashi K, Hashimoto T, Iguchi M, Shimizu Y, Ichinose M, Omata M (2004) Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection. Endoscopy 36:584–589

    Article  CAS  PubMed  Google Scholar 

  32. Parker SM, Gibson GJ (2007) Evaluation of a transcutaneous carbon dioxide monitor (“TOSCA”) in adult patients in routine respiratory practice. Respir Med 101:261–264

    Article  CAS  PubMed  Google Scholar 

  33. Maniscalco M, Zedda A, Faraone S, Carratu P, Sofia M (2008) Evaluation of a transcutaneous carbon dioxide monitor in severe obesity. Intensive Care Med 34:1340–1344

    Article  PubMed  Google Scholar 

  34. Carter BG, Wiwczaruk D, Hochmann M, Osborne A, Henning R (2001) Performance of transcutaneous PCO2 and pulse oximetry monitors in newborns and infants after cardiac surgery. Anaesth Intensive Care 29:260–265

    CAS  PubMed  Google Scholar 

  35. Eberhard P, Gisiger PA, Gardaz JP, Spahn DR (2002) Combining transcutaneous blood gas measurement and pulse oximetry. Anesth Analg 94:76–80

    Google Scholar 

  36. Rohling R, Biro P (1999) Clinical investigation of a new combined pulse oximetry and carbon dioxide tension sensor in adult anaesthesia. J Clin Monit Comput 15:23–27

    Article  CAS  PubMed  Google Scholar 

  37. Sumanac K, Zealley I, Fox BM, Rawlinson J, Salena B, Marshall JK, Stevenson GW, Hunt RH (2002) Minimizing postcolonoscopy abdominal pain by using CO2 insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO2 delivery system. Gastrointest Endosc 56:190–194

    Article  PubMed  Google Scholar 

  38. Inoue H, Endo M, Takeshita K, Yoshino K, Muraoka Y, Yoneshima H (1992) A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope (EMRC). Surg Endosc 6:264–265

    Article  CAS  PubMed  Google Scholar 

  39. Nelson DB, Freeman ML, Silvis SE, Cass OW, Yakshe PN, Vennes J, Stahnke LL, Herman M, Hodges J (2000) A randomized, controlled trial of transcutaneous carbon dioxide monitoring during ERCP. Gastrointest Endosc 51:288–295

    Article  CAS  PubMed  Google Scholar 

  40. Bell GD (2000) Premedication, preparation, and surveillance. Endoscopy 32:92–100

    Article  CAS  PubMed  Google Scholar 

  41. Bolliger D, Steiner LA, Kasper J, Aziz OA, Filipovic M, Seeberger MD (2007) The accuracy of noninvasive carbon dioxide monitoring: a clinical evaluation of two transcutaneous systems. Anaesthesia 62:394–399

    Article  CAS  PubMed  Google Scholar 

  42. Oda I, Gotoda T, Sasako M, Sano T, Katai H, Fukagawa T, Shimoda T, Emura F, Saito D (2008) Treatment strategy after noncurative endoscopic resection of early gastric cancer. Br J Surg 95:1495–1500

    Article  CAS  PubMed  Google Scholar 

  43. Imagawa A, Fujiki S, Kawahara Y, Matsushita H, Ota S, Tomoda T, Morito Y, Sakakihara I, Fujimoto T, Taira A, Tsugeno H, Kawano S, Yagi S, Takenaka R (2008) Satisfaction with bispectral index monitoring of propofol-mediated sedation during endoscopic submucosal dissection: a prospective, randomized study. Endoscopy 40:905–909

    Article  CAS  PubMed  Google Scholar 

  44. Lazzaroni M, Porro Bianchi (2005) Preparation, premedication, and surveillance. Endoscopy 37:101–109

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Mr. Christopher Dix for editing the manuscript. This study was partly supported by the Japanese Foundation for Research and Promotion of Endoscopy. Although the CO2 regulator prototype was provided by the Olympus Optical Co., Ltd., Tokyo, Japan, this was not a collaborative study.

Disclosures

Satoru Nonaka, Yutaka Saito, Hajime Takisawa, Yongmin Kim, Tsuyoshi Kikuchi, and Ichiro Oda have no conflict of interests or financial ties to disclose.

Author information

Authors and Affiliations

  1. Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Satoru Nonaka, Yutaka Saito, Hajime Takisawa, Yongmin Kim, Tsuyoshi Kikuchi & Ichiro Oda

Authors
  1. Satoru Nonaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yutaka Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hajime Takisawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yongmin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tsuyoshi Kikuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ichiro Oda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yutaka Saito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nonaka, S., Saito, Y., Takisawa, H. et al. Safety of carbon dioxide insufflation for upper gastrointestinal tract endoscopic treatment of patients under deep sedation. Surg Endosc 24, 1638–1645 (2010). https://doi.org/10.1007/s00464-009-0824-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0824-5

Keywords

Search

Navigation