Effectiveness of CO 2-insufflated endoscopic submucosal dissection with the duodenal balloon occlusion method for early esophageal or gastric cancer: a randomized case control prospective study

Abstract

Background: Endoscopic submucosal dissection (ESD) has typically been performed using air insufflation. Recently, however, insufflation of CO 2 has been increasingly used to avoid complications. This prospective study was designed to compare the CO 2 concentration, intestinal volume, and acid-base balance using the duodenal balloon procedure.Methods: From June 2010 to February 2011, we enrolled 44 patients with esophageal or gastric cancer and randomly allocated them into two groups. We compared 22 patients undergoing CO 2-insufflated ESD with a balloon placed into the duodenal bulb (duodenal balloon group) and 22 patients undergoing regular CO 2-insufflated ESD (regular group). Three-dimensional computed tomography was performed before and after the procedure to measure intestinal volume. CO 2 concentrations were measured every 10 minutes. The visual analogue system (VAS) scores for postoperative symptoms were recorded, and pH was measured immediately after the procedure. This was a prospective case control study randomized by the sealed envelope method.Results: Intestinal CO 2 gas volume before and after ESD was lower in the duodenal balloon group than in the regular group (P = 0.00027). The end-tidal CO 2 level was significantly lower in the duodenal balloon group than in the regular group (P = 0.0001). No significant differences in blood ΔpH were found between the two groups. The VAS score for the occurrence of nausea due to abdominal distension after ESD indicated a significant difference (P = 0.031).Conclusions: ESD using the duodenal balloon occlusion method is effective for reduction of post-ESD intestinal CO 2 gas volume, resulting in a lower total amount of CO 2 insufflation during ESD and reducing harmful influences on the human body to some extent. © 2012 Mori et al; licensee BioMed Central Ltd.