A Research Of Carbon Dioxide Insufflation For Efficacy And Safety In Colorectal ESD And EMR

Aims:To assess the safety and efficacy of CO2 insufflation instead of air insufflation during colorectal endoscopic submucosal dissection(ESD) and endoscopic submucosal resection (EMR).Methods:We randomized 43 patients to undergo colorectal EMR or ESD into two groups, with insufflation of air (n=22) or CO2 (n=21). End tidal pCO2 [p (ETCO2)], a non-invasive parameter of arterial pCO2, was registered before and during the operation at 4 time points:arrived caecum, before the lesion was resected, after he lesion was resected, after the operation. Patient's experience of pain during and after the operation at 1 h,3 h,6 h and 24 h were registered using a visual analogue scale (VAS). Other outcomes included the amount of flatus passed after the operation and operation time were registered.Results:CO2 insufflation was used in 21 patients(48.84%) and air in 22 patients(51.16%). The groups were similar in age, sex, BMI and the rate of ESD(all P> 0.05). No rise in p (ET CO2) was registered in both two groups. There were statistically significant differences in VAS scores after the operation at 1h,3h and 6h between two groups with less pain reported when using CO2(all P<0.05). But there are no significant differences in VAS scores at 24 hours and during the operation. The amount of flatus passed at 1h,3h and 6h were significantly less in the CO2 group(P<0.05).Conclusions:This randomised study of unsedated patients shows that CO2 insufflation during colorectal EMR or ESD may significantly reduce the pain, with no CO2 retention and no rise of hemorrhage or perforation, which is safe and effective.