Brief Article
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World J Gastroenterol. Dec 28, 2012; 18(48): 7296-7301
Published online Dec 28, 2012. doi: 10.3748/wjg.v18.i48.7296
Comparison between air and carbon dioxide insufflation in the endoscopic submucosal excavation of gastrointestinal stromal tumors
Wei-Bin Shi, Zi-Hao Wang, Chun-Ying Qu, Yi Zhang, Han Jiang, Min Zhou, Ying Chen, Lei-Ming Xu
Wei-Bin Shi, Zi-Hao Wang, Han Jiang, Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China
Chun-Ying Qu, Yi Zhang, Min Zhou, Ying Chen, Lei-Ming Xu, Digestive Endoscopic Diagnosis and Treatment Center, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China
Chun-Ying Qu, Yi Zhang, Min Zhou, Ying Chen, Lei-Ming Xu, Shanghai Key Laboratory of Pediatric Digestion and Nutrition, Shanghai 200092, China
Author contributions: Shi WB and Wang ZH contributed equally to this work; Wang ZH, Zhou M and Xu LM performed the majority of experiments; Qu CY and Chen Y provided vital reagents and analytical tools; Zhang Y, Jiang H and Zhou M analyzed data; and Shi WB, Wang ZH and Xu LM wrote the paper.
Supported by Grants from Project of Science and Technology Commission of Shanghai Municipality, No. 10441901702; Nano-specific Project of Science and Technology Commission of Shanghai Municipality, No. 11nm0503700; and Shanghai Key Laboratory of Pediatric Digestion and Nutrition, No. 11DZ2260500
Correspondence to: Dr. Lei-Ming Xu, Chief Physician, Digestive Endoscopic Diagnosis and Treatment Center, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China. leiming.xu@yahoo.com.cn
Telephone: +86-21-65790000 Fax: +86-21-65790000
Received: September 14, 2012
Revised: October 30, 2012
Accepted: December 5, 2012
Published online: December 28, 2012
Processing time: 137 Days and 22.9 Hours
Abstract

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) undergoing CO2 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.

Keywords: Carbon dioxide insufflation; Endoscopic submucosal excavation; Gastrointestinal tract; Stromal tumor; Treatment