A randomized, controlled, double-blind trial of air insufflation versus carbon dioxide insufflation during ERCP.

Gastrointestinal Endoscopy

PubMedID: 20493485

Dellon ES, Velayudham A, Clarke BW, Isaacs KL, Gangarosa LM, Galanko JA, Grimm IS. A randomized, controlled, double-blind trial of air insufflation versus carbon dioxide insufflation during ERCP. Gastrointest Endosc. 2010;72(1):68-77.
BACKGROUND
Visualization during GI endoscopy requires distention of the bowel lumen. Carbon dioxide (CO(2)) insufflation decreases postprocedure abdominal discomfort and distension after colonoscopy, but there have been few published studies on its use in ERCP.

OBJECTIVE
To assess the safety and efficacy of CO(2) insufflation during ERCP.

DESIGN
Double-blind, controlled, randomized trial.

SETTING
Tertiary-care referral center.

PATIENTS
This study involved consecutive patients referred for ERCP, excluding those with known CO(2) retention or with chronic use of opiate medications.

INTERVENTION
Insufflation of CO(2) versus insufflation of air.

MAIN OUTCOME MEASUREMENTS
Primary outcomes were abdominal pain assessed on a visual analogue scale and abdominal distension. Secondary outcomes included transcutaneous CO(2) levels (pCO(2)) and procedural complications.

RESULTS
We analyzed 74 patients, 38 in the air group and 36 in the CO(2) group. Pain scores were similar in both groups 1-hour postprocedure (16 vs 11 mm in the CO(2) and air groups, respectively; P = .29) as well as over the subsequent 24 hours. There were also no significant differences between groups in abdominal distension or pCO(2) levels. There were 13 patients with complications in the air group and 5 in the CO(2) group (P = .04; nominal significance removed by Bonferroni correction), although most complications were minor in nature.

LIMITATIONS
Single-center study.

CONCLUSION
The use of CO(2) for insufflation during ERCP was safe in a tertiary-care referral population. However, use of CO(2) during ERCP did not lead to decreased postprocedural pain or less abdominal distension, so its role in this procedure remains in question. NCT00685386.