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Transcutaneous monitoring of partial pressure of carbon dioxide during endoscopic submucosal dissection of early colorectal neoplasia with carbon dioxide insufflation: a prospective study

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Abstract

Background

The authors have reported that carbon dioxide (CO2) insufflation is safe and effective for lengthy endoscopic submucosal dissection (ESD) with the patient under conscious sedation. However, CO2 monitoring has not been assessed to clarify whether partial pressure of carbon dioxide (PCO2) increases during this type of long procedure. This study aimed to monitor CO2 before, during, and after ESD to investigate whether CO2 insufflation is safe for patients receiving a lengthy ESD of early colorectal neoplasia under conscious sedation.

Methods

This study prospectively enrolled 35 consecutive patients who underwent ESD at the National Cancer Center Hospital. Transcutaneous PCO2 (PtcCO2) was measured with a noninvasive sensor before, during, and after ESD for patients under conscious sedation using midazolam.

Results

The mean size of removed lesions was 44 ± 22 mm (range, 15–100 mm). The operation time was 90 ± 100 min (range, 15–600 mm). The dose of midazolam was 5.7 ± 4.0 mg (range, 2–19 mg). The mean PtcCO2 was 41 ± 5 mmHg (range, 33–53 mmHg) before ESD and 44 ± 6 mmHg (range, 32–54 mmHg) afterward. The mean peak PtcCO2 during ESD was 55 ± 7 mmHg (range, 39–78 mmHg), which was significantly higher than before or after ESD (p < 0.0001). However, no complication associated with CO2 insufflation such as CO2 narcosis, gas embolism, or arrhythmia needing treatment was seen in any of the cases.

Conclusions

This study suggests that CO2 insufflation is safe for patients receiving a lengthy colorectal ESD under conscious sedation.

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Disclosures

Tsuyoshi Kikuchi, Kuang-I Fu, Yutaka Saito, Toshio Uraoka, Masakatsu Fukuzawa, Syusei Fukunaga, Taku Sakamoto, Takeshi Nakajima, and Takahisa Matsuda have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

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

    Tsuyoshi Kikuchi, Yutaka Saito, Toshio Uraoka, Masakatsu Fukuzawa, Syusei Fukunaga, Taku Sakamoto, Takeshi Nakajima & Takahisa Matsuda

  2. Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan

    Kuang-I Fu

Authors
  1. Tsuyoshi Kikuchi
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  2. Kuang-I Fu
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  3. Yutaka Saito
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  4. Toshio Uraoka
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  5. Masakatsu Fukuzawa
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  6. Syusei Fukunaga
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  7. Taku Sakamoto
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  8. Takeshi Nakajima
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  9. Takahisa Matsuda
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Corresponding author

Correspondence to Yutaka Saito.

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Kikuchi, T., Fu, KI., Saito, Y. et al. Transcutaneous monitoring of partial pressure of carbon dioxide during endoscopic submucosal dissection of early colorectal neoplasia with carbon dioxide insufflation: a prospective study. Surg Endosc 24, 2231–2235 (2010). https://doi.org/10.1007/s00464-010-0939-8

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  • DOI: https://doi.org/10.1007/s00464-010-0939-8

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