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Comparison of carbon dioxide and air insufflation use by non‐expert endoscopists during endoscopic retrograde cholangiopancreatography
Author(s) -
Muraki Takashi,
Arakura Norikazu,
Kodama Ryou,
Yoneda Suguru,
Maruyama Masafumi,
Itou Tetsuya,
Watanabe Takayuki,
Maruyama Masahiro,
Matsumoto Akihiro,
Kawa Shigeyuki,
Tanaka Eiji
Publication year - 2013
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2012.01344.x
Subject(s) - medicine , insufflation , endoscopic retrograde cholangiopancreatography , anesthesia , adverse effect , surgery , pancreatitis
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is subject to several complications that include a lengthy procedure time, technical difficulty, and active bowel movement induced by air insufflation. In ERCP carried out by non‐expert endoscopists who are prone to excessive luminal insufflation, insufflation with carbon dioxide (CO 2 ) may provide better and safer outcomes. We aimed to assess the efficacy and safety of CO 2 insufflation during ERCP by non‐expert endoscopists. Methods: This study included 208 consecutive patients who received ERCP, excluding those in poor general health or with obstructive lung disease. The first operator for each patient was a non‐expert endoscopist having done 50 or fewer ERCP procedures. Primary outcomes were the changes in cardiopulmonary state during ERCP. Secondary outcomes were ERCP complications. We designed a single‐center, randomized, prospective, double‐blind, controlled trial with CO 2 and air insufflation during ERCP. Results: CO 2 insufflation did not affect overall procedure progression or results. A positive correlation was observed between procedure time and change in maximal systolic blood pressure from baseline among patients in the air insufflation group, but not in the CO 2 insufflation group (correlation coefficient 0.408 vs 0.114, change in the maximal systolic blood pressure from baseline +4.2 vs +1.2 mmHg/10 min). This was consistent with our findings in patients treated by the first operator alone. The occurrence rate of post‐ERCP pancreatitis tended to be lower in the CO 2 group than the air group (4/102 [3.9%] vs 0/106 [0%], P = 0.056). Conclusions: CO 2 insufflation during ERCP by non‐expert endoscopists is recommended from the standpoints of efficacy and safety.