Efficacy of carbon dioxide versus air insufflation according to different sedation protocols during therapeutic endoscopic retrograde cholangiopancreatography: prospective, randomized, double-blind study.

BACKGROUND AND AIM

Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) tends to require considerable air insufflation, which results in abdominal pain or distension. We investigated the efficacy of carbon dioxide (CO2 ) compared with air insufflation when using two different sedation protocols in therapeutic ERCP.

METHODS

Patients who required therapeutic ERCP were randomly assigned to four groups based on preliminary data: air insufflation with balanced propofol sedation (BPS), air with propofol + opioid sedation (PS), CO2 with BPS, and CO2 with PS. Post-ERCP abdominal pain, distension and nausea by the 10-point visual analogue scale (VAS), and gas volume score (GVS) by the four-point ordinal scale were measured according to the time interval. Overall satisfaction with sedation, sedation efficacy, and complications were also measured.

RESULTS

The CO2 with BPS group showed lowest mean VAS score for abdominal pain (immediately after recovery, P = 0.002; and 3 h post-ERCP, P = 0.047) and distension (immediately after recovery, P = 0.018; 3 h post-ERCP, P < 0.01; and 24 h post-ERCP, P = 0.042). Overall satisfaction with sedation was greater in the CO2 with BPS group (P = 0.005). Mean GVS at 2 h and 12 h post-ERCP was significantly lower in the CO2 with BPS group (P < 0.05). There were no significant differences in procedure or sedation-related complications.

CONCLUSION

CO2 with BPS showed the lowest VAS score for early abdominal pain, distension and GVS, and had a higher score for overall satisfaction for sedation.