Effectiveness of CO2-insufflated endoscopic submucosal dissection with the duodenal balloon occlusion method for early esophageal or gastric cancer: a randomized case control prospective study

BMC Gastroenterology, 04/30/2012

Endoscopic submucosal dissection (ESD) using the duodenal balloon occlusion method is effective for reduction of post–ESD intestinal CO2 gas volume, resulting in a lower total amount of CO2 insufflation during ESD and reducing harmful influences on the human body to some extent.

Methods

  • From June 2010 to February 2011, the authors enrolled 44 patients with esophageal or gastric cancer and randomly allocated them into two groups.
  • They compared 22 patients undergoing CO2- insufflated ESD with a balloon placed into the duodenal bulb (duodenal balloon group) and 22 patients undergoing regular CO2-insufflated ESD (regular group).
  • Three-dimensional computed tomography was performed before and after the procedure to measure intestinal volume.
  • CO2 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 CO2 gas volume before and after ESD was lower in the duodenal balloon group than in the regular group (P = 0.00027).
  • The end-tidal CO2 level was significantly lower in the duodenal balloon group than in the regular group (P = 0.0001).
  • No significant differences in blood DeltapH 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).

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