Abstract
BackgroundCarbon dioxide (CO2) insufflation is increasingly used for endoscopic submucosal dissection (ESD) owing to the faster absorption of CO2 as compared to that of air. Studies comparing CO2 insufflation and air insufflation have reported conflicting results.ObjectivesThis meta-analysis is aimed to assess the efficacy and safety of use of CO2 insufflation for ESD.MethodsClinical trials of CO2 insufflation versus air insufflation for ESD were searched in PubMed, Embase, the Cochrane Library and Chinese Biomedical Literature Database. We performed a meta-analysis of all randomized controlled trials (RCTs).ResultsEleven studies which compared the use of CO2 insufflation and air insufflation, with a combined study population of 1026 patients, were included in the meta-analysis (n = 506 for CO2 insufflation; n = 522 for air insufflation). Abdominal pain and VAS scores at 6h and 24h post-procedure in the CO2 insufflation group were significantly lower than those in the air insufflation group, but not at 1h and 3h after ESD. The percentage of patients who experienced pain 1h and 24h post-procedure was obviously decreased. Use of CO2 insufflation was associated with lower VAS scores for abdominal distention at 1h after ESD, but not at 24h after ESD. However, no significant differences were observed with respect to postoperative transcutaneous partial pressure carbon dioxide (PtcCO2), arterial blood carbon dioxide partial pressure (PaCO2), oxygen saturation (SpO2%), abdominal circumference, hospital stay, white blood cell (WBC) counts, C-Reactive protein (CRP) level, dosage of sedatives used, incidence of dysphagia and other complications.ConclusionUse of CO2 insufflation for ESD was safe and effective with regard to abdominal discomfort, procedure time, and the residual gas volume. However, there appeared no significant differences with respect to other parameters namely, PtcCO2, PaCO2, SpO2%, abdominal circumference, hospital stay, sedation dosage, complications, WBC, CRP, and dysphagia.
Highlights
Endoscopic submucosal dissection (ESD) allows lesions to be dissected and resected directly along the submucosal layer with use of an electrosurgical knife
Use of CO2 insufflation was associated with lower visual analogue scale (VAS) scores for abdominal distention at 1h after ESD, but not at 24h after ESD
No significant differences were observed with respect to postoperative transcutaneous partial pressure carbon dioxide (PtcCO2), arterial blood carbon dioxide partial pressure (PaCO2), oxygen saturation (SpO2%), abdominal circumference, hospital
Summary
Endoscopic submucosal dissection (ESD) allows lesions to be dissected and resected directly along the submucosal (sm) layer with use of an electrosurgical knife. With rapid advances in endoscopic techniques, ESD has become an invaluable tool in the treatment of early neoplasms of the gastrointestinal tract, for large lesions[1]. This procedure is timeconsuming and requires special endoscopic experience. Two meta-analyses of studies which compared the use of CO2 insufflation versus air insufflation for gastrointestinal endoscopy and endoscopic retrograde cholangiopancreatography (ERCP) reinforced the advantages of CO2 insufflation (lower post-procedural pain and bowel distension); they did not find any advantage with respect to arterial blood CO2 partial pressure (PaCO2) and transcutaneous partial pressure CO2 (PtcCO2) levels[8, 9]. Studies comparing CO2 insufflation and air insufflation have reported conflicting results
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