Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China.
World J Gastroenterol. 2012 Dec 28;18(48):7296-301. doi: 10.3748/wjg.v18.i48.7296.
To evaluate the safety and efficacy of CO(2) insufflation compared with air insufflation in the endoscopic submucosal excavation (ESE) of gastrointestinal stromal tumors.
Sixty patients were randomized to undergo endoscopic submucosal excavation, with the CO(2) group (n = 30) and the air group (n = 30) undergoing CO(2) insufflation and air insufflation in the ESE, respectively. The end-tidal CO(2) level (pETCO(2)) was observed at 4 time points: at the beginning of ESE, at total removal of the tumors, at completed wound management, and 10 min after ESE. Additionally, the patients' experience of pain at 1, 3, 6 and 24 h after the examination was registered using a visual analog scale (VAS).
Both the CO(2) group and air group were similar in mean age, sex, body mass index (all P > 0.05). There were no significant differences in PetCO(2) values before and after the procedure (P > 0.05). However, the pain scores after the ESE at different time points in the CO(2) group decreased significantly compared with the air group (1 h: 21.2 ± 3.4 vs 61.5 ± 1.7; 3 h: 8.5 ± 0.7 vs 42.9 ± 1.3; 6 h: 4.4 ± 1.6 vs 27.6 ± 1.2; 24 h: 2.3 ± 0.4 vs 21.4 ± 0.7, P < 0.05). Meanwhile, the percentage of VAS scores of 0 in the CO(2) group after 1, 3, 6 and 24 h was significantly higher than that in the air group (60.7 ± 1.4 vs 18.9 ± 1.5, 81.5 ± 2.3 vs 20.6 ± 1.2, 89.2 ± 0.7 vs 36.8 ± 0.9, 91.3 ± 0.8 vs 63.8 ± 1.3, respectively, P < 0.05). Moreover, the condition of the CO(2) group was better than that of the air group with respect to anal exsufflation.
Insufflation of CO(2) in the ESE of gastrointestinal stromal tumors will not cause CO(2) retention and it may significantly reduce the level of pain, thus it is safe and effective.
评估 CO2 充气与空气充气在胃肠间质瘤内镜黏膜下挖除术（ESE）中的安全性和疗效。
将 60 名患者随机分为 ESE 组，CO2 组（n=30）和空气组（n=30）分别采用 CO2 充气和空气充气。在 4 个时间点观察呼气末 CO2 水平（pETCO2）：ESE 开始时、肿瘤完全切除时、完成伤口处理时和 ESE 后 10 分钟。此外，使用视觉模拟评分（VAS）记录患者在检查后 1、3、6 和 24 小时的疼痛程度。
CO2 组和空气组的平均年龄、性别、体重指数（均 P > 0.05）相似。手术前后 pETCO2 值无显著差异（P > 0.05）。然而，CO2 组在 ESE 后不同时间点的疼痛评分明显低于空气组（1 小时：21.2±3.4 比 61.5±1.7；3 小时：8.5±0.7 比 42.9±1.3；6 小时：4.4±1.6 比 27.6±1.2；24 小时：2.3±0.4 比 21.4±0.7，P < 0.05）。同时，CO2 组在 1、3、6 和 24 小时后 VAS 评分 0 的比例明显高于空气组（60.7±1.4 比 18.9±1.5，81.5±2.3 比 20.6±1.2，89.2±0.7 比 36.8±0.9，91.3±0.8 比 63.8±1.3，P < 0.05）。此外，CO2 组的肛门排气情况优于空气组。
胃肠间质瘤 ESE 中 CO2 充气不会引起 CO2 潴留，可能显著降低疼痛程度，安全有效。
