Carbon dioxide insufflation compared with air insufflation in double-balloon enteroscopy: a prospective, randomized, double-blind trial

Background Few studies have evaluated the degree of pain, the amount of retained gas, and the safety of carbon dioxide (CO2 ) insufflation in patients undergoing double-balloon enteroscopy (DBE). Objective To clarify the usefulness and safety of CO2 insufflation during DBE. Design Single-center, pro...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2011-04, Vol.73 (4), p.743-749
Main Authors: Hirai, Fumihito, MD, PhD, Beppu, Takahiro, MD, Nishimura, Taku, MD, Takatsu, Noritaka, MD, Ashizuka, Shinya, MD, PhD, Seki, Takehiko, MD, Hisabe, Takashi, MD, PhD, Nagahama, Takashi, MD, PhD, Yao, Kenshi, MD, PhD, Matsui, Toshiyuki, MD, PhD, Beppu, Tsuyoshi, MD, Nakashima, Rikiya, MD, PhD, Inada, Naomi, BSN, Tajiri, Eriko, BSN, Mitsuru, Hideko, BSN, Shigematsu, Hideko, BSN
Format: Article
Language:English
Subjects:
Adult
Air
Biological and medical sciences
Blood Gas Analysis
Carbon Dioxide - administration & dosage
Carbon Dioxide - pharmacokinetics
Digestive system. Abdomen
Double-Balloon Enteroscopy - methods
Double-Blind Method
Endoscopy
Female
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Insufflation - methods
Intestinal Diseases - blood
Intestinal Diseases - diagnosis
Intestine, Small
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
Oxygen - blood
Prospective Studies
Reproducibility of Results
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Summary:Background Few studies have evaluated the degree of pain, the amount of retained gas, and the safety of carbon dioxide (CO2 ) insufflation in patients undergoing double-balloon enteroscopy (DBE). Objective To clarify the usefulness and safety of CO2 insufflation during DBE. Design Single-center, prospective, randomized, double-blind, controlled trial. Setting University hospital. Patients Forty eligible patients with small-bowel disease for whom DBE was indicated were randomized to a CO2 insufflation (CO2 ) group or an air insufflation (air) group by means of sealed envelopes. Intervention DBE with insufflation of CO2 or air. Main Outcome Measurements Efficacy evaluation was based on the degree of pain as assessed by use of a visual analog scale (VAS) and the amount of residual gas retention within the small and large bowels on radiography. The safety of CO2 insufflation was evaluated by arterial blood gas analysis. Results Significantly fewer patients in the CO2 group had severe pain of ≥50 mm on the VAS during DBE than in the air group ( P = .02). Significantly less gas was retained in the small bowel just after and at 3 hours after DBE in the CO2 group than in the air group ( P = .003, P = .01, respectively). There was significantly less residual gas retention in the large bowel at 3 hours after DBE in the CO2 group than in the air group ( P = .02). There was no significant difference in pre-DBE and post-DBE partial pressure of oxygen in the blood (PaO2 ) and partial pressure of carbon dioxide in the blood (PaCO2 ) between groups. Limitations Small sample size. Conclusion CO2 insufflation is a safe and useful procedure when performed during DBE.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2010.10.003