Endoscopy 2010; 42(12): 1021-1029
DOI: 10.1055/s-0030-1255969
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Prolonged carbon dioxide insufflation under general anesthesia for endoscopic submucosal dissection

T.  Suzuki1 , H.  Minami2 , T.  Komatsu1 , R.  Masusda1 , 3 , Y.  Kobayashi1 , 4 , A.  Sakamoto1 , Y.  Sato2 , H.  Inoue2 , K.  Serada1
  • 1Department of Anesthesia, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
  • 2Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
  • 3Department of Dental Anesthesiology, Showa University Dental Hospital, Tokyo, Japan
  • 4Emergency Intensive Care Center, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
Further Information

Publication History

submitted 1 June 2010

accepted after revision 24 October 2010

Publication Date:
30 November 2010 (online)

Background and study aims: Carbon dioxide (CO2) insufflation for endoscopy has been reported to provide superior recovery and is expected to reduce the risk of serious complications, including air embolism and tension pneumothorax, whereas general anesthesia offers some advantages not found under intravenous sedation. Little is known about the effect of prolonged CO2 insufflation into gastrointestinal tracts on arterial CO2 tension (PaCO2). Here we introduce the use of general anesthesia with CO2 insufflation for esophagogastroduodenal endoscopic submucosal dissection (ESD).

Patients and methods: A prospective observational study was conducted in a university-affiliated hospital. A total of 100 patients were scheduled for esophagogastroduodenal ESD under general anesthesia with CO2 insufflation, using standardized anesthesia techniques and unchanged ventilatory settings. Arterial blood gas analyses were repeated at predetermined time intervals.

Results: Of the initial 100 participants, 94 patients undergoing ESD and four patients undergoing endoscopic mucosal resection completed the study. The median procedure time was 122 minutes (range 29 – 309 minutes). The median baseline PaCO2 of 28 mmHg increased to a median peak PaCO2 of 39 mmHg (P < 0.001), with marked inter-individual variability in the time courses of changes in PaCO2. The correlation coefficient of PaCO2 with the procedure time was low (r = 0.194; n = 577, P < 0.0001). FEV1.0 % (forced expiratory volume in 1 second/forced vital capacity) of < 70 % and esophagoscopy vs. gastroduodenoscopy were relative enhancement factors of PaCO2.

Conclusion: Increases of PaCO2 during esophagogastroduodenal ESD under general anesthesia with CO2 insufflation remained within acceptable or readily controllable ranges, and are little enhanced by prolongation of the procedure. Esophagogastroduodenal ESD can be performed safely and feasibly with this procedure.


T. Suzuki, MD, PhD 

Department of Anesthesia
Showa University Northern Yokohama Hospital

35-1 Chigasaki-chuo
Yokohama 224-8503

Fax: +81-45-9497365

Email: [email protected]