Case StudyA pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation
Section snippets
Patients
Between November 2004 and May 2005, a total of 35 consecutive patients were enrolled in this study at the National Cancer Center Hospital (NCCH) in Tokyo. All ESD procedures were performed by one or the other of 2 highly experienced colonoscopists (Y.S., T.U.).
Colorectal ESDs with air insufflation performed in 35 other consecutive patients by the same 2 colonoscopists between September 2003 and November 2004 were compared as a historical control group. Patients with severe chronic occlusive
Results
There were no differences in clinicopathologic characteristics between the groups (Table 1). The mean (SD) size of the resected specimens was 32 ± 15 mm in the CO2 group and 30 ± 14 mm in the control group, with no statistical difference (NS). En bloc resection was achieved in 30 of 35 cases (86%) in the CO2 group and 31 of 35 cases (89%) in the control group.
Histopathologic evaluation revealed 5 low-grade dysplasias, 24 high-grade dysplasias, and 6 submucosal (sm) carcinomas in the CO2 group.
Discussion
Based on the results of this pilot study, CO2 insufflation proved to be safe and effective during lengthy colonic endoscopic procedures (eg, ESD) with the patient under conscious sedation. Patient discomfort was considerably lower in the CO2 group, probably because of a more rapid absorption of CO2 than was caused by conventional air insufflation, as evidenced by the lower total dosage of midazolam.
In the field of conventional colonoscopy, the safety and efficacy of CO2 insufflation has already
Conclusions
This study strongly suggests that CO2 insufflation is safe and effective during lengthy colonic endoscopic procedures (eg, ESD) with the patient under conscious sedation. It is possible, however, that a significant component of the reduced midazolam dosage in the CO2 group might have been the technical improvement of the experienced endoscopists between the time of the control cases and the current series.
Acknowledgments
We thank Dr Yoshitaka Murakami for reading our draft and giving us suggestions on statistical analyses.
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Presented in part at the American Society for Gastrointestinal Endoscopy meeting, May 23, 2006, Los Angeles, California.