Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7373
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
To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema (ME) immediately after endoscopic submucosal dissection (ESD).
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.
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).
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.