Carbon dioxide insufflation is superior to air insufflation during endoscopic retrograde cholangiopancreatography: A randomized trial

Abstract

Background: Carbon dioxide (CO₂) insufflation has been shown to be superior to air insufflation in colonoscopy, and double balloon enteroscopy. However, the value of CO₂ insufflation in endoscopic retrograde cholangiopancreatography (ERCP) is not established. This study aims to assess the efficacy and safety of CO₂ insufflation during ERCP. Materials and Methods: Consecutive patients referred for ERCP at a single center were randomized to either air or CO₂ insufflation during ERCP. The primary objectives were a post-ERCP abdominal pain (measured by 10 cm visual analog scale [VAS] 30 and 90 min, and 3 h and 24 h after ERCP). Secondary objectives included end-tidal CO₂ (ETCO₂) values and procedural complications. Results: We randomized 298 patients; 149 into air group and 149 into CO₂ group. The VAS score for pain was higher in the air group compared to the CO₂ group at 30 min, with a median of 1 (interquartile range 1–0) versus median of 1 (interquartile range 1–0); P = 0.031 and 90 min after the procedure with a median of 0 (interquartile range 1–0) versus median of 0 (interquartile range 0–0); P = 0.006. There were no serious adverse events, and the ETCO₂ was within normal limits in both groups. Conclusions: CO₂ insufflation is superior to air insufflation during ERCP with regard to patient pain and discomfort and warrants wide adoption. Clinical Trials.gov registration number NCT 01321203.

Key words

Air insufflation - carbon dioxide insufflation - endoscopic retrograde cholangiopancreatogram

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