Brief Article
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World J Gastroenterol. Jul 21, 2012; 18(27): 3565-3570
Published online Jul 21, 2012. doi: 10.3748/wjg.v18.i27.3565
Inhibitory effects of carbon dioxide insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy
Shinji Nishiwaki, Hiroshi Araki, Motoshi Hayashi, Jun Takada, Masahide Iwashita, Atsushi Tagami, Hiroo Hatakeyama, Takao Hayashi, Teruo Maeda, Koshiro Saito
Shinji Nishiwaki, Motoshi Hayashi, Jun Takada, Masahide Iwashita, Atsushi Tagami, Hiroo Hatakeyama, Takao Hayashi, Teruo Maeda, Koshiro Saito, Department of Internal Medicine, Nishimino Kosei Hospital, Gifu 503-1394, Japan
Hiroshi Araki, Department of Gastroenterology, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan
Author contributions: Nishiwaki S and Araki H contributed the study design, acquisition and interpretation of data, and documentation of the manuscript; Hayashi M, Takada J and Tagami A acquired the data; Iwashita M and Hatakeyama H analyzed and interpreted the data; Hayashi T and Maeda T wrote the manuscript; Saito K finally approved the contents of the manuscript.
Correspondence to: Dr. Shinji Nishiwaki, MD, PhD, Department of Internal Medicine, Nishimino Kosei Hospital, 986 Oshikoshi, Yoro-cho, Yoro-gun, Gifu 503-1394, Japan. wakky@nishimino.gfkosei.or.jp
Telephone: +81-58-4321161 Fax: +81-58-4322856
Received: November 28, 2011
Revised: March 16, 2012
Accepted: March 20, 2012
Published online: July 21, 2012
Abstract

AIM: To evaluate the inhibitory effects of carbon dioxide (CO2) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).

METHODS: A total of 73 consecutive patients who were undergoing PEG were enrolled in our study. After eliminating 13 patients who fitted our exclusion criteria, 60 patients were randomly assigned to either CO2 (30 patients) or air insufflation (30 patients) groups. PEG was performed by pull-through technique after three-point fixation of the gastric wall to the abdominal wall using a gastropexy device. Arterial blood gas analysis was performed immediately before and after the procedure. Abdominal X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel distension. Abdominal computed tomography was performed at 24 h after the procedure to detect the presence of pneumoperitoneum. The outcomes of PEG for 7 d post-procedure were also investigated.

RESULTS: Among 30 patients each for the air and the CO2 groups, PEG could not be conducted in 2 patients of the CO2 group, thus they were excluded. Analyses of the remaining 58 patients showed that the patients’ backgrounds were not significantly different between the two groups. The elevation values of arterial partial pressure of CO2 in the air group and the CO2 group were 2.67 mmHg and 3.32 mmHg, respectively (P = 0.408). The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO2 group compared to the air group (P < 0.001) at 10 min and 24 h after PEG, whereas there was no significant difference in large bowel distension between the two groups. Pneumoperitoneum was observed only in the air group but not in the CO2 group (P = 0.003). There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two groups.

CONCLUSION: There was no adverse event associated with CO2 insufflation. CO2 insufflation is considered to be safer and more comfortable for PEG patients because of the lower incidence of pneumoperitoneum and less distension of the small bowel.

Keywords: Percutaneous endoscopic gastrostomy, Carbon dioxide insufflation, Pneumoperitoneum, Abdominal distension, Randomized control study