, Volume 24, Issue 7, pp 1638-1645

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

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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.


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).


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.


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.