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01-07-2015

Safety of carbon dioxide insufflation during gastric endoscopic submucosal dissection in patients with pulmonary dysfunction under conscious sedation

Authors: Jun Takada, Hiroshi Araki, Fumito Onogi, Takayuki Nakanishi, Masaya Kubota, Takashi Ibuka, Masahito Shimizu, Hisataka Moriwaki

Published in: Surgical Endoscopy | Issue 7/2015

Abstract

Background

Carbon dioxide (CO₂) 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 CO₂ insufflation during gastric ESD in patients with pulmonary dysfunction under conscious sedation.

Methods

We analyzed 322 consecutive patients undergoing ESD using CO₂ 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_1.0%) <70 % or vital capacity <80 %. Transcutaneous partial pressure of CO₂ (PtcCO₂) was recorded before, during, and after ESD.

Results

In total, 127 patients (39 %) had pulmonary dysfunction. There were no significant differences in baseline PtcCO₂ before ESD, peak PtcCO₂ during ESD, and median PtcCO₂ after ESD between the pulmonary dysfunction group and normal group. There was a significant correlation between PtcCO₂ elevation from baseline and ESD procedure time (r = 0.22, P < 0.05) only in the pulmonary dysfunction group. In patients with FEV_1.0% <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. CO₂ narcosis or gas embolism was not reported in either group.

Conclusions

CO₂ 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_1.0% <60 %, longer procedure time may induce CO₂ retention, thus requiring CO₂ monitoring.

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Title: Safety of carbon dioxide insufflation during gastric endoscopic submucosal dissection in patients with pulmonary dysfunction under conscious sedation
Authors: Jun Takada
Hiroshi Araki
Fumito Onogi
Takayuki Nakanishi
Masaya Kubota
Takashi Ibuka
Masahito Shimizu
Hisataka Moriwaki
Publication date: 01-07-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3892-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Safety of carbon dioxide insufflation during gastric endoscopic submucosal dissection in patients with pulmonary dysfunction under conscious sedation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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