ENDOSCOPIC EXAMINATION AND TREATMENT USING CARBON DIOXIDE INSUFFLATION

Abstract

It is well known that carbon dioxide (CO₂) is absorbed faster in the body than air and also rapidly excreted through respiration. With the relatively recent development and increasingly widespread use of endoscopic submucosal dissection (ESD) as a minimally invasive treatment, ESD for early gastrointestinal (GI) neoplasms in the esophagus, stomach and colorectum has risen dramatically. Quite naturally, the number of complications including perforations as well as procedure times have also increased during the technically more difficult ESD. CO₂ insufflation can reduce abdominal pain and patient discomfort caused by bowel hyperextension, perforation-related subcutaneous/mediastinal emphysema and pneumoperitoneum. Although CO₂ insufflation has been used in colonoscopy from the mid-1980s in Western countries, its use is still limited in Japan. We have recently reported that CO₂ insufflation can be used as safely as air insufflation in ESD procedures in the esophagus, stomach and colorectum. Based on our results, we fully expect that CO₂ insufflation will become a standard method for GI endoscopy.