Carbon Dioxide Role in GI Endoscopy
Journal Title: The Egyptian Journal of Hospital Medicine - Year 2018, Vol 70, Issue 4
Abstract
<strong>Background: </strong>Sufficient distension of the GI lumen is needed for safe advancement of endoscopes and for careful visualization of the mucosa. Carbon dioxide (CO<sub>2</sub>) has been proposed as an alternative to room air for insufflation. <strong>Aim of the Study:</strong> To assess the merits and demerits of the use CO<sub>2</sub> insufflation for endoscopy in terms of safety and efficacy. <strong>Methods:</strong> Electronic and manual searches were combined to search RCTs (Randomized controlled trials). After methodological quality assessment and data extraction, the efficacy and safety of CO<sub>2</sub> insufflation were systematically assessed<strong>.</strong> <strong>Results:</strong> Ten RCTs met the eligibility criteria and included in the present study; six of which on colonoscopy, two on endoscopic retrograde cholangiopancreatography (ERCP) and two on double-balloon enteroscopy (DBE). Postprocedural pain was assessed. Overall, pain was lower in the CO<sub>2</sub> insufflation group compared with the air group. Two RCTs found decreased flatus in the CO<sub>2</sub> group compared with the air group, and 3 RCTs showed there was decreased bowel distention on abdominal radiography in the CO<sub>2</sub> group compared with the air group. Moreover, CO<sub>2</sub> insufflation revealed no consistent advantages in the RCTs of DBE, yet it was still indicated safe as air insufflation in stomach/ oesophagus endoscopic submucosal dissection. PCO<sub>2</sub> level showed no significant variation during these procedures. <strong>Conclusion:</strong> CO<sub>2</sub> insufflation is proven to be associated with decreased postprocedural pain, flatus, and bowel distention. CO<sub>2</sub> insufflation also appears to be safe in patients without severe underlying pulmonary disease.
Authors and Affiliations
Eman Helal
Keywords
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