Carbon dioxide insufflation reduces number of postprocedure admissions after endoscopic resection of large colonic lesions: a prospective cohort study.

BACKGROUND

Endoscopic resection (ER) for large colonic lesions is a safe and effective outpatient treatment. Postprocedural pain creates concern for perforation and often results in postprocedure admission (PPA). Carbon dioxide (CO(2)) insufflation has been shown to reduce pain scores after routine colonoscopy, but an influence on more critical outcomes such as PPA has not been shown.

OBJECTIVE

To assess the outcomes of patients undergoing ER for large colonic lesions, comparing those having air versus those having CO(2) insufflation.

DESIGN

Prospective, observational, cohort study.

SETTING

Academic, high-volume, tertiary-care referral center.

PATIENTS

Consecutive patients referred for ER of sessile colorectal polyps ≥20 mm.

INTERVENTION

ER with air or CO(2).

MAIN OUTCOME MEASUREMENTS

Rates of PPA, technical outcomes, complication rates.

RESULTS

ER was performed on 575 lesions ≥20 mm, 228 with CO(2) insufflation. Mean lesion size was 36.5 mm. Lesion and patient characteristics were similar in both groups. The use of CO(2) was associated with a 62% decrease in the PPA rate from 8.9% to 3.4% (P = .01). This was mainly because of an 82% decrease in PPA for pain from 5.7% to 1.0% (P = .006). There were no significant difference in the rates of complications. Multiple logistical regression was performed. The adjusted odds ratio (OR) of PPA (OR 0.39; 95% confidence interval [CI], 0.16-0.95; P = .04) and PPA for pain (OR 0.18; 95% CI, 0.04-0.78; P = .02) in the CO(2) group remained significant.

LIMITATIONS

Single center, nonrandomized study.

CONCLUSION

CO(2) insufflation significantly reduces PPA after ER of large colonic lesions, primarily because of reduced PPA for pain. CO(2) insufflation should be routinely used during ER of large colonic lesions.