Maeda Y, Hirasawa D, Fujita N, Ohira T, Harada Y, Yamagata T, Koike Y, Suzuki K. Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial. World J Gastroenterol 2016; 22(32): 7373-7382 [PMID: 27621583 DOI: 10.3748/wjg.v22.i32.7373]
Corresponding Author of This Article
Yuki Maeda, MD, Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai 983-0824, Japan. maeda@openhp.or.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yuki Maeda, Dai Hirasawa, Tetsuya Ohira, Yoshihiro Harada, Taku Yamagata, Yoshiki Koike, Kenjirou Suzuki, Department of Gastroenterology, Sendai City Medical Center, Sendai 983-0824, Japan
Naotaka Fujita, Miyagi Medical Check-up Plaza, Sendai 984-0015, Japan
Author contributions: Maeda Y and Hirasawa D conceived of and designed this study; Maeda Y, Hirasawa D, Ohira T, Harada Y, Yamagata T, Suzuki K and Koike Y acquired the data; Maeda Y and Hirasawa D performed analysis and interpretation of the data; Maeda Y drafted the manuscript and performed statistical analysis; Hirasawa D and Fujita N provided administrative, technical and material support and supervised the study.
Institutional review board statement: This study was approved by the institutional review board of Sendai City Medical Center.
Clinical trial registration statement: The trial was registered with the UMIN Clinical Trials Registry (No. UMIN000006441).
Informed consent statement: All participants provided written informed consent prior to enrollment in the study.
Conflict-of-interest statement: None of the authors have any conflicts of interest concerning this clinical research.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yuki Maeda, MD, Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai 983-0824, Japan. maeda@openhp.or.jp
Telephone: +81-22-2521111 Fax: +81-22-2529431
Received: March 9, 2016 Peer-review started: March 9, 2016 First decision: March 31, 2016 Revised: April 27, 2016 Accepted: May 23, 2016 Article in press: May 23, 2016 Published online: August 28, 2016 Processing time: 168 Days and 10.1 Hours
Abstract
AIM
To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema (ME) immediately after endoscopic submucosal dissection (ESD).
METHODS
A total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation (CO2 group, n = 24) or air insufflation (Air group, n = 22). Computed tomography (CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale (VAS). The volume of residual gas in the digestive tract was measured using CT imaging.
RESULTS
The incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group (17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively (P = 0.066). There were no differences in pain scores or distention scores at any post-procedure time points. The volume of residual gas in the digestive tract immediately after ESD was significantly smaller in the CO2 group than that in the Air group (808 mL vs 1173 mL, P = 0.013).
CONCLUSION
CO2 insufflation during esophageal ESD significantly reduced postprocedural ME. CO2 insufflation also reduced the volume of residual gas in the digestive tract immediately after ESD, but not the VAS scores of pain and distention.
Core tip: This randomized, double-blind, controlled trial assessed the efficacy of CO2 insufflation for reduction of mediastinal emphysema immediately after endoscopic submucosal dissection (ESD). This study showed that CO2 insufflation during esophageal ESD significantly reduced postprocedural mediastinal emphysema. CO2 insufflation also reduced the volume of residual gas in the digestive tract immediately after ESD, but not the visual analogue scale scores of pain and distention.
