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- Title
Safety of carbon dioxide insufflation during gastric endoscopic submucosal dissection in patients with pulmonary dysfunction under conscious sedation.
- Authors
Takada, Jun; Araki, Hiroshi; Onogi, Fumito; Nakanishi, Takayuki; Kubota, Masaya; Ibuka, Takashi; Shimizu, Masahito; Moriwaki, Hisataka
- Abstract
Background: Carbon dioxide (CO) insufflation is effective for gastric endoscopic submucosal dissection (ESD). However, its safety is unknown in patients with pulmonary dysfunction. This study aimed to investigate the safety of CO insufflation during gastric ESD in patients with pulmonary dysfunction under conscious sedation. Methods: We analyzed 322 consecutive patients undergoing ESD using CO insufflation (1.4 L/min) for gastric lesions. Pulmonary dysfunction was defined as a forced expiratory volume in 1.0 s/forced vital capacity (FEV%) <70 % or vital capacity <80 %. Transcutaneous partial pressure of CO (PtcCO) was recorded before, during, and after ESD. Results: In total, 127 patients (39 %) had pulmonary dysfunction. There were no significant differences in baseline PtcCO before ESD, peak PtcCO during ESD, and median PtcCO after ESD between the pulmonary dysfunction group and normal group. There was a significant correlation between PtcCO elevation from baseline and ESD procedure time ( r = 0.22, P < 0.05) only in the pulmonary dysfunction group. In patients with FEV% <60 %, the correlation was much stronger ( r = 0.39, P < 0.05). Neither the complication incidences nor the hospital stay differed between the two groups. CO narcosis or gas embolism was not reported in either group. Conclusions: CO insufflation during gastric ESD in patients with pulmonary dysfunction under conscious sedation is safe with regard to complication risk and hospital stay. However, in patients with severe obstructive lung disease, especially in those with FEV% <60 %, longer procedure time may induce CO retention, thus requiring CO monitoring.
- Subjects
ENDOSCOPIC surgery; LUNG disease treatment; INSUFFLATION; STOMACH cancer; GAS embolism
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2015, Vol 29, Issue 7, p1963
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-014-3892-0