Open Access
CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(05): E468-E473
DOI: 10.1055/a-2048-1312
Original article

Invasive CO2 monitoring with arterial line compared to end tidal CO2 during peroral endoscopic myotomy[*]

1   Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
,
Amy Tyberg
1   Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
,
Avik Sarkar
1   Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
,
Haroon M. Shahid
1   Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
,
Bhargav Vemulapalli
1   Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
,
Sardar Shah-Khan
1   Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
,
Monica Gaidhane
1   Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
,
1   Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
› Author Affiliations
TRIAL REGISTRATION: Retrospective study NCT05041608 at ClinicalTrials.gov (http://www.clinicaltrials.gov/)
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Abstract

Background and study aims Peroral endoscopic myotomy (POEM) has become a recognized treatment for achalasia. The technique requires CO2 insufflation. It is estimated that the partial pressure of CO2 (PaCO2) is 2 to 5 mm Hg higher than the end tidal CO2 (etCO2), and etCO2 is used as a surrogate for PaCO2 because PaCO2 requires an arterial line. However, no study has compared invasive and noninvasive CO2 monitoring during POEM.

Patients and methods Seventy-one patients who underwent POEM were included in a prospective comparative study. PaCO2 plus etCO2 was measured in 32 patients (invasive group) and etCO2 only in 39 matched patients (noninvasive group). Pearson correlation coefficient (PCC) and Spearman’s Rho were used to calculate the correlation between PaCO2 and ETCO2.

Results PaCO2 and ETCO2 were strongly correlated: PCC R value: 0.8787 P ≤ 0.00001, Spearman’s Rho R value: 0.8775, P ≤ 0.00001. Within the invasive group, the average difference between PaCO2 and ETCO2 was 3.39 mm Hg (median 3, standard deviation 3.5), within the 2- to 5-mm Hg range. The average procedure time (scope in to scope out) was increased 17.7 minutes (P = 0.044) and anesthesia duration was 46.3 minutes. Adverse events (AEs) included three hematomas and one nerve injury in the invasive group and one pneumothorax in the noninvasive group. There were no differences in AE rates between the groups (13 % vs 3 % P = 0.24).

Conclusions Universal PaCO2 monitoring contributes to increased procedure and anesthesia times without any decrease in AEs in patients undergoing POEM. CO2 monitoring with an arterial line should only be performed in patients with major cardiovascular comorbidities; in all other patients, ETCO2 is an appropriate tool.

* Digestive Disease Week: This study was presented as an abstract during DDW 2022




Publication History

Received: 08 September 2022

Accepted after revision: 10 February 2022

Accepted Manuscript online:
06 March 2023

Article published online:
09 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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