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Carbon dioxide insufflation during colorectal endoscopic submucosal dissection for patients with obstructive ventilatory disturbance

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Abstract

Purpose

Carbon dioxide (CO2) insufflation reduces abdominal pain and discomfort after endoscopic procedures; however, there is no previous study focusing the safety of CO2 insufflation for patients with obstructive ventilatory disturbance. Here, we investigated the safety of CO2 insufflation during colorectal endoscopic submucosal dissection (ESD) for patients with obstructive disturbance.

Methods

Between January 2010 and January 2013, colorectal ESD was performed using CO2 insufflation for 385 consecutive patients. End-tidal CO2 (EtCO2) and transcutaneous oxygen saturation (SpO2) were consecutively measured from the time before insertion of the colonoscope to the end of ESD. Patients were monitored by two nurses during the procedure and controlled for clinical symptoms of hypercapnia such as apnea or a depressed level of consciousness. According to their respiratory function, patients were stratified into a normal group and an obstructive disturbance group. We retrospectively compared EtCO2 and SpO2 during the procedures and the incidence of symptoms related to CO2 retention between the two groups.

Results

The obstructive disturbance group consisted of 77 patients. There were similar changes of EtCO2 in the obstructive disturbance group and normal group and no significant rise in EtCO2. The maximum EtCO2 level in any patient was <60 mmHg. In the obstructive disturbance group, there were no symptoms associated with CO2 retention. There were no significant differences in the median SpO2 between both groups and no prolonged drop of SpO2.

Conclusions

CO2 insufflation during colorectal ESD is safe for patients with obstructive ventilatory disturbance.

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Acknowledgments

A prototype of the IT knife nanoTM was provided by Olympus, Tokyo, Japan, as part of a cooperation.

Conflict of interest

The authors have declared that no competing interests exist.

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Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, Japan

    Masao Yoshida, Kenichiro Imai, Kinichi Hotta, Yuichiro Yamaguchi, Masaki Tanaka, Naomi Kakushima, Kohei Takizawa, Hiroyuki Matsubayashi & Hiroyuki Ono

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  1. Masao Yoshida
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  2. Kenichiro Imai
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Correspondence to Masao Yoshida.

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Yoshida, M., Imai, K., Hotta, K. et al. Carbon dioxide insufflation during colorectal endoscopic submucosal dissection for patients with obstructive ventilatory disturbance. Int J Colorectal Dis 29, 365–371 (2014). https://doi.org/10.1007/s00384-013-1806-6

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  • DOI: https://doi.org/10.1007/s00384-013-1806-6

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