Carbon dioxide insufflation during colorectal endoscopic submucosal dissection for patients with obstructive ventilatory disturbance

Abstract

Carbon dioxide (CO(2)) insufflation reduces abdominal pain and discomfort after endoscopic procedures; however, there is no previous study focusing the safety of CO(2) insufflation for patients with obstructive ventilatory disturbance. Here, we investigated the safety of CO(2) insufflation during colorectal endoscopic submucosal dissection (ESD) for patients with obstructive disturbance. Between January 2010 and January 2013, colorectal ESD was performed using CO(2) insufflation for 385 consecutive patients. End-tidal CO(2) (EtCO(2)) and transcutaneous oxygen saturation (SpO(2)) were consecutively measured from the time before insertion of the colonoscope to the end of ESD. Patients were monitored by two nurses during the procedure and controlled for clinical symptoms of hypercapnia such as apnea or a depressed level of consciousness. According to their respiratory function, patients were stratified into a normal group and an obstructive disturbance group. We retrospectively compared EtCO(2) and SpO(2) during the procedures and the incidence of symptoms related to CO(2) retention between the two groups. The obstructive disturbance group consisted of 77 patients. There were similar changes of EtCO(2) in the obstructive disturbance group and normal group and no significant rise in EtCO(2). The maximum EtCO(2) level in any patient was <60 mmHg. In the obstructive disturbance group, there were no symptoms associated with CO(2) retention. There were no significant differences in the median SpO(2) between both groups and no prolonged drop of SpO(2). CO(2) insufflation during colorectal ESD is safe for patients with obstructive ventilatory disturbance.