Abstract :
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure for diagnosis
and treatment of many hepatobilliary tract diseases. Patients may suffer from abdominal pain and distension due to
air insufflation during the procedure. Previous studies confirmed the benefit of using carbon dioxide (CO2) in
colonoscopy but still controversial in ERCP. The primary outcome of this study was to compare the difference in
pain score after ERCP between using CO2 and air insufflation. The secondary outcome was the difference of
abdominal circumference after ERCP, side effect of CO2 and ERCP complications between two groups.
Methods: Between April 2012 and February 2013, 77 patients who underwent ERCP were enrolled and
randomized to receive CO2 or air insufflations. ERCP was performed under sedated with midazolam plus pethidine
or fentanyl. The abdominal pain was evaluated by 10-point visual analog scales (VAS) before and at 1, 3 and 6
hours after procedure. The waist circumference was measured before and after ERCP, complication of procedure
and CO2 were recorded.
Results: Fifty seven patients (27 in CO2 group and 30 in air group) were enrolled in the study. The CO2
and air groups were similar in demographic data, indication for ERCP, duration of ERCP and post ERCP diagnosis.
Mean of pain scores at 1 and 3 hours post-ERCP were higher in air insufflation group than in CO2 insufflation
group but no statistical significance (2.17 vs. 1.52, p=0.35 and 1.48 vs. 1.70, p=0.71 respectively). In contrast,
patients who received CO2 had significantly lesser difference in waist circumference after ERCP than those who
received air (1.81±1.84 cm vs. 3.52±2.97 cm respectively, p=0.011). There was no significant difference in ERCP
complications and no patient reported adverse event of CO2.
Conclusions: CO2 insufflation during ERCP was safe and might reduce abdominal distension. Further
study should be performed to establish this benefit. |
file/Thai-Journal-of-gastroenterology-vol-14-no-3-796472.pdf