Inhibitory effects of carbon dioxide insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy.

AIM To evaluate the inhibitory effects of carbon dioxide (CO(2)) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG). METHODS A total of 73 consecutive patients who were undergoing PEG were enrolled in our study. After eliminating 13 patients who fitted our exclusion criteria, 60 patients were randomly assigned to either CO(2) (30 patients) or air insufflation (30 patients) groups. PEG was performed by pull-through technique after three-point fixation of the gastric wall to the abdominal wall using a gastropexy device. Arterial blood gas analysis was performed immediately before and after the procedure. Abdominal X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel distension. Abdominal computed tomography was performed at 24 h after the procedure to detect the presence of pneumoperitoneum. The outcomes of PEG for 7 d post-procedure were also investigated. RESULTS Among 30 patients each for the air and the CO(2) groups, PEG could not be conducted in 2 patients of the CO(2) group, thus they were excluded. Analyses of the remaining 58 patients showed that the patients' backgrounds were not significantly different between the two groups. The elevation values of arterial partial pressure of CO(2) in the air group and the CO(2) group were 2.67 mmHg and 3.32 mmHg, respectively (P = 0.408). The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO(2) group compared to the air group (P < 0.001) at 10 min and 24 h after PEG, whereas there was no significant difference in large bowel distension between the two groups. Pneumoperitoneum was observed only in the air group but not in the CO(2) group (P = 0.003). There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two groups. CONCLUSION There was no adverse event associated with CO(2) insufflation. CO(2) insufflation is considered to be safer and more comfortable for PEG patients because of the lower incidence of pneumoperitoneum and less distension of the small bowel.

[1]  A. Sakamoto,et al.  Prolonged carbon dioxide insufflation under general anesthesia for endoscopic submucosal dissection. , 2010, Endoscopy.

[2]  E. Dellon,et al.  A randomized, controlled, double-blind trial of air insufflation versus carbon dioxide insufflation during ERCP. , 2010, Gastrointestinal endoscopy.

[3]  Y. Kominami,et al.  Carbon dioxide insufflation is useful for obtaining clear images of the bile duct during peroral cholangioscopy (with video). , 2010, Gastrointestinal endoscopy.

[4]  T. Matsuda,et al.  Transcutaneous monitoring of partial pressure of carbon dioxide during endoscopic submucosal dissection of early colorectal neoplasia with carbon dioxide insufflation: a prospective study , 2010, Surgical Endoscopy.

[5]  I. Oda,et al.  Safety of carbon dioxide insufflation for upper gastrointestinal tract endoscopic treatment of patients under deep sedation , 2010, Surgical Endoscopy.

[6]  R. Keswani,et al.  Carbon dioxide insufflation during ERCP for reduction of postprocedure pain: a randomized, double-blind, controlled trial. , 2009, Gastrointestinal endoscopy.

[7]  Stuart M. Leon,et al.  The Incidence and Clinical Significance of Pneumoperitoneum after Percutaneous Endoscopic Gastrostomy: A Review of 722 Cases , 2009, The American surgeon.

[8]  M. Bretthauer,et al.  Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled, double-blind trial. , 2007, Endoscopy.

[9]  S. Stawicki,et al.  Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. , 2007, Journal of gastrointestinal and liver diseases : JGLD.

[10]  T. Matsuda,et al.  A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. , 2007, Gastrointestinal endoscopy.

[11]  S. Bank,et al.  True incidence and clinical significance of pneumoperitoneum after PEG placement: a prospective study. , 2006, Gastrointestinal endoscopy.

[12]  J. Milsom,et al.  Intraoperative carbon dioxide colonoscopy: a safe insufflation alternative for locating colonic lesions during laparoscopic surgery , 2005, Surgical Endoscopy And Other Interventional Techniques.

[13]  E. J. Rutherford,et al.  The Incidence and Significance of Free Air after Percutaneous Endoscopic Gastrostomy , 2002, The American surgeon.

[14]  J. Ponsky,et al.  Gastrostomy without laparotomy: a percutaneous endoscopic technique. 1980. , 1998, Nutrition.

[15]  M. Freeman,et al.  A randomized, controlled trial of transcutaneous carbon dioxide monitoring during ERCP. , 1997, Gastrointestinal endoscopy.

[16]  G. Norman,et al.  Pain following colonoscopy: elimination with carbon dioxide. , 1992, Gastrointestinal endoscopy.

[17]  B. Rogers,et al.  Stabilizing sutures for percutaneous endoscopic gastrostomy. , 1989, Gastrointestinal endoscopy.

[18]  M. Wojtowycz,et al.  CT findings after uncomplicated percutaneous gastrostomy. , 1988, AJR. American journal of roentgenology.

[19]  M. Clair,et al.  Pneumoperitoneum following percutaneous endoscopic gastrostomy. A prospective study. , 1986, Gastrointestinal endoscopy.

[20]  C. Bartram,et al.  Carbon dioxide insufflation for more comfortable colonoscopy. , 1984, Gastrointestinal endoscopy.

[21]  J. Ponsky,et al.  Gastrostomy without laparotomy: a percutaneous endoscopic technique. , 1980, Journal of pediatric surgery.

[22]  B. Rogers,et al.  The safety of carbon dioxide insufflation during colonoscopic electrosurgical polypectomy. , 1974, Gastrointestinal endoscopy.

[23]  M. Bretthauer,et al.  Carbon dioxide insufflation for more comfortable endoscopic retrograde cholangiopancreatography: a randomized, controlled, double-blind trial. , 2007, Endoscopy.