Accuracy of carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography using double-balloon endoscopy

Table 1 Clinical results of ouble-balloon endoscopic retrograde cholangiography

Clinical results	n = 52
Male:female	32:20
Age (years old, mean ± SD)	62.5 ± 17.6
Types of branch
Jejuno-jejunal anastomosis	33
(Roux-en Y reconstruction, liver transplantation)
Gastro-jejunal anastomosis	19
(Billroth II, panceatoduodenectomy)
Indications
Cholangitis	20
Biliary stone	13
Jaundice	7
Suspected tumor	5
Hyperamilasemia	3
Stenosis at anastomosis	2
Foreign body in the bile duct	1
Abdominal pain	1
Reached target, n (%)	50/52 (96.1)
Exmination time
Insertion time, minutes (range)	15.2 (5.0-90.7)
Teeth-branch, minutes (range)	5.0 (1.3-25.5)
Branch-target, minutes (range)	8.2 (3.3-72.4)
Total examination, minutes (range)	60.3 (20.6-165.6)
Sedations
Midazolam, n [median (range)]	49 [10 mg (2.5-40))
Pentazocine, n [median (range)]	49 [15 mg (7.5-45)]
Dexmedetomidine, n (dose)	3 (137, 103, 80 µg)
General anethtesia, n	3
Interventions
EPBD with biliary stone extraction	12
Biliary stone extraction	10
Balloon dilation of the anastomosis stricture	7
ENBD	4
Metallic stent placement	3
Endoscopic sphincterotomy	1
Extraction of foreign body	1

EPBD: Endoscopic papillary balloon dilatation; ENBD: Endoscopic nasobiliary drainage.

Table 2 Correct rate for route selection

Total
Correct on visual (%)	36/52 (69.2)
Correct on CDE (%)	48/52 (92.3)1
Jejuno-jejunal anastomosis
Correct on visual (%)	20/33 (60.6)
Correct on CDE (%)	29/33 (87.8)2
Billroth II, Pancreatoduodenectomy
Correct on visual (%)	16/19 (82.3)
Correct on CDE (%)	19/19 (100)3

Visual vs carbon dioxide insufflation enterography,

¹P = 0.002,

²P = 0.012,

³P = 0.250. CDE: Carbon dioxide insufflation enterography.

Table 3 Comparison of clinical results according to evaluation groups

Group	A	B	C	D	P value1
Evaluation 1: Visual observation	Correct	Correct	Incorrect	Incorrect
Evaluation 2: CDE	Correct	Incorrect	Correct	Incorrect
n	35	1	13	3
Age	59.4 (21.4)	76	56.3 (23.3)	67.3 (6.0)	0.568
Male	20	0	9	3
Insertion time [minutes, mean (SD)]	16.9 (14.9)2	90	25.5 (22.3)	68.3 (45.0)	0.008
Incisor tooth to branch [minutes, mean (SD)]	4.8 (4.1)	20	8.5 (7.7)	16.6 (12.3)	0.042
Branch- target [minutes, mean (SD)]	12.0 (13.2)3	70	17.0 (18.1)	52.6 (32.5)	0.014
Total examination time [minutes, mean (SD)]	62.9 (26.6)	165	73.0 (33.9)	82.0 (33)	0.229
Treatment, n	26	0	7	0
Baseline CRP (mg/dL, mean (SD))	2.2 (4.0)	3.5	2.6 (2.7)	0.10 (0.11)
Baseline serum amylase [IU/L, mean (SD)]	175 (220)	793	138 (100)	118 (58)

¹Krustal-Wallis test.

²P = 0.042 (vs Group D).

³P = 0.047 (vs Group D), Mann-Whitney U test, Bonferroni correction. CRP: C-reactive protein; CDE: Carbon dioxide insufflation enterography.

Table 4 Univariate analysis influencing factors for dose of sedation

Factors	Univariate analysis
	P value	Odds ratio	95%CI
			Lower limit	Upper limit
Age (less than 65 yr)	0.241	0.500	0.157	1.594
Gender	0.556	0.708	0.224	2.240
Correct visual selection	0.700	1.286	0.358	4.617
Correct CDE	0.770	0.655	0.039	11.119
Intervention	0.466	0.643	0.196	2.108
Insertion time (more than 22 min.)	0.895	0.917	0.251	3.350
Total examination time (more than 80 min.)	0.797	1.179	0.377	4.125
CRP level normal	0.805	1.167	0.344	3.956
Serum amylase level normal	0.432	0.583	0.152	2.240
Billroth II and PD	0.721	0.808	0.250	2.612
Previous surgery more than 2 times	0.270	0.467	0.120	1.810

CDE: Carbon dioxide insufflation enterography; CRP: C-reactive protein.

Table 5 Univariate and multivariate analyses influencing factors for dose of pentazocine

Factors	Univariate analysis				Multivariate analysis
	P value	Odds ratio	95%CI		P value	Odds ratio	95%CI
			Lower limit	Upper limit			Lower limit	Upper limit
Age (less than 65 yr)	0.025	12.429	1.362	113.410	0.033	11.338	1.232	105.219
Gender	0.868	0.872	0.173	4.392
Correct visual selection	0.999	-	-	-
Correct CDE	0.999	-	-	-
Intervention	0.744	1.339	0.231	7.751
Insertion time (more than 22 min)	0.283	2.475	0.473	12.961
Total examination time (more than 80 min)	0.353	2.182	0.421	11.318
CRP level normal	0.834	1.207	0.208	7.012
Serum amylase level normal	0.867	1.164	0.197	6.891
Billroth II and PD	0.582	0.612	0.106	3.521
Previous surgery more than 2 times	0.166	0.305	0.057	1.639	0.313	0.389	0.062	2.431

CDE: Carbon dioxide insufflation enterography; CRP: C-reactive protein.