Comparison between air and carbon dioxide insufflation in the endoscopic submucosal excavation of gastrointestinal stromal tumors

• Published in: World journal of gastroenterology : WJG 2012-12, Vol.18 (48), p.7296-7301
• Main Authors: Shi, Wei-Bin, Wang, Zi-Hao, Qu, Chun-Ying, Zhang, Yi, Jiang, Han, Zhou, Min, Chen, Ying, Xu, Lei-Ming
• Format: Article
• Language: English
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - etiology; Adult; Aged; Air; Brief; Carbon Dioxide - chemistry; CO2气; Digestive System Surgical Procedures - methods; Endoscopy - methods; Female; Gases; Gastrointestinal Stromal Tumors - surgery; Gastrointestinal Tract - surgery; Humans; Insufflation; Male; Middle Aged; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Stomach Neoplasms - surgery; Time Factors; 二氧化碳气; 内镜; 挖掘; 空气; 胃肠道; 膜下; 间质
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v18.i48.7296

AIM：To evaluate the safety and efficacy of CO2 insufflation compared with air insufflation in the endoscopic submucosal excavation（ESE） of gastrointestinal stromal tumors.METHODS：Sixty patients were randomized to undergo endoscopic submucosal excavation,with the CO2 group（n = 30） and the air group（n = 30） undergoingCO2 insufflation and air insufflation in the ESE,respectively.The end-tidal CO2 level（pETCO2） was observed at 4 time points：at the beginning of ESE,at total removal of the tumors,at completed wound management,and 10 min after ESE.Additionally,the patients＇ experience of pain at 1,3,6 and 24 h after the examination was registered using a visual analog scale（VAS）.RESULTS：Both the CO2 group and air group were similar in mean age,sex,body mass index（all P 〉 0.05）.There were no significant differences in PetCO2 values before and after the procedure（P 〉 0.05）.However,the pain scores after the ESE at different time points in the CO2 group decreased significantly compared with the air group（1 h：21.2 ± 3.4 vs 61.5 ± 1.7;3 h：8.5 ± 0.7 vs 42.9 ± 1.3;6 h：4.4 ± 1.6 vs 27.6 ± 1.2;24 h：2.3 ± 0.4 vs 21.4 ± 0.7,P 〈 0.05）.Meanwhile,the percentage of VAS scores of 0 in the CO2 group after 1,3,6 and 24 h was significantly higher than that in the air group（60.7 ± 1.4 vs 18.9 ± 1.5,81.5 ± 2.3 vs 20.6 ± 1.2,89.2 ± 0.7 vs 36.8 ± 0.9,91.3 ± 0.8 vs 63.8 ± 1.3,respectively,P 〈 0.05）.Moreover,the condition of the CO2 group was better than that of the air group with respect to anal exsufflation.CONCLUSION：Insufflation of CO2 in the ESE of gastrointestinal stromal tumors will not cause CO2 retention and it may significantly reduce the level of pain,thus it is safe and effective.