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

Mori H et al. – 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.

• 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.

• 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).