CO2 insufflation during single-balloon enteroscopy: a multicenter randomized controlled trial

Philipp Lenz; Tobias Meister; Mauro Manno; Marco Pennazio; Rita Conigliaro; Sven Lebkücher; Hansjoerg Ullerich; Andre Schmedt; Martin Floer; Torsten Beyna; Frank Lenze; Dirk Domagk

doi:10.1055/s-0033-1359041

Endoscopy, Inhaltsverzeichnis

Endoscopy 2014; 46(01): 53-58
DOI: 10.1055/s-0033-1359041

Original article

CO₂ insufflation during single-balloon enteroscopy: a multicenter randomized controlled trial

Philipp Lenz^*

¹Department of Medicine B, University of Münster, Münster, Germany

²European Institute for Molecular Imaging, University of Münster, Münster, Germany

,

Tobias Meister^*

³Department of Medicine II, Helios Albert-Schweitzer University Teaching Hospital Northeim, Northeim, Germany

,

Mauro Manno

⁴Gastroenterology and Digestive Endoscopy Unit, New S. Agostino-Estense Civil Hospital, Baggiovara di Modena, Modena, Italy

,

Marco Pennazio

⁵Division of Gastroenterology 2, San Giovanni Battista University Teaching Hospital, Turin, Italy

,

Rita Conigliaro

⁴Gastroenterology and Digestive Endoscopy Unit, New S. Agostino-Estense Civil Hospital, Baggiovara di Modena, Modena, Italy

,

Sven Lebkücher

¹Department of Medicine B, University of Münster, Münster, Germany

,

Hansjoerg Ullerich

¹Department of Medicine B, University of Münster, Münster, Germany

,

Andre Schmedt

¹Department of Medicine B, University of Münster, Münster, Germany

,

Martin Floer

³Department of Medicine II, Helios Albert-Schweitzer University Teaching Hospital Northeim, Northeim, Germany

,

Torsten Beyna

¹Department of Medicine B, University of Münster, Münster, Germany

,

Frank Lenze

¹Department of Medicine B, University of Münster, Münster, Germany

,

Dirk Domagk

¹Department of Medicine B, University of Münster, Münster, Germany

› Institutsangaben

Abstract

Background and study aims: Carbon dioxide (CO₂₎ insufflation has previously been shown to have advantages over air insufflation in terms of procedure-related pain and oral insertion depth during double-balloon enteroscopy. The aim of this prospective study was to evaluate the performance of CO₂ vs. air insufflation during single-balloon enteroscopy.

Patients and methods: This study was a randomized European multicenter trial (ClinicalTrials.gov: NCT01524055). Patients and endoscopists were blinded to the type of insufflation gas used. Patient discomfort during and after the procedure was scored using a visual analog scale.

Results: A total of 107 patients were enrolled in the study (52 in the CO₂ group and 55 in the air group). Patient characteristics were comparable in both groups. The mean (± SD) oral intubation depth was not significantly deeper in the CO₂ group vs. the air group (254 ± 80 vs. 238 ± 55 cm; P = 0.726). However, in patients with previous abdominal surgery, oral intubation depth was significantly higher in the CO₂ group compared with the air group (258 ± 84 vs. 192 ± 42 cm; P < 0.05). In patients undergoing SBE via the anal approach, CO₂ showed no significant difference in intubation depth compared with air insufflation (86 ± 67 vs. 110 ± 68 cm; P = 0.155). The diagnostic yield was comparable (CO₂ 67 %; air 73 %). Procedure times, dosage of sedation, and therapeutic interventions did not differ between the two groups. Patients in the CO₂ group reported less pain than those in the air group.

Conclusions: This study demonstrated an advantage of using CO₂ insufflation during single-balloon enteroscopy in patients with a history of previous abdominal surgery. Overall, single-balloon enteroscopy was a well-tolerated procedure that may benefit from the use of CO₂ insufflation to reduce post-procedural pain.

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Referenzen

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