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Endoscopy 2011; 43(12): 1070-1075
DOI: 10.1055/s-0030-1256764
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Carbon dioxide insufflation vs. conventional saline irrigation for peroral video cholangioscopy

S. Doi
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
I. Yasuda
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
M. Nakashima
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
T. Iwashita
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
K. Toda
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
T. Mukai
2   Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
,
K. Iwata
2   Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
,
T. Itoi
3   Fourth Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan
,
H. Moriwaki
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
› Author Affiliations
Further Information

Publication History

submitted 06 December 2010

accepted after revision09 June 2011

Publication Date:
04 October 2011 (online)

Also available at
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Background and study aims: Recent studies have evaluated the efficacy of peroral cholangioscopy (POCS) for diagnosis of biliary diseases. In order to obtain clear images with POCS, saline irrigation, which is performed to replace yellow bile, is carried out for an extended duration. The aim of this study was to evaluate the feasibility of replacing saline irrigation with CO2 insufflation during POCS.

Patients and methods: A total of 36 patients who had bile duct lesions and were due to undergo POCS were enrolled in the study. Of these patients, 18 underwent POCS using saline irrigation followed by CO2 insufflation, and 18 patients underwent the reverse approach. The two methods were compared with regard to the time required to obtain a clear endoscopic image and the quality of the images.

Results: The median time required to obtain a clear endoscopic image using CO2 insufflation (5.0 min) was significantly shorter than that required for saline irrigation (22.5 min; P < 0.001). The quality of the endoscopic images obtained was similar in 27 cases. However, CO2 insufflation provided better images in four cases that showed an abundance of mucin or biliary sludge, and saline irrigation was superior to CO2 insufflation in five cases that showed severe stricture with bleeding and tall papillary lesions.

Conclusions: CO2 insufflation during POCS can reduce procedure time and simplify cholangioscopy. The overall image quality was similar to that obtained with conventional saline irrigation.

 

  • References

  • 1 Kawai K, Nakajima M, Akasaka Y et al [A new endoscopic method: the peroral choledocho-pancreatoscopy (author's transl)]. Leber Magen Darm 1976; 6: 121-124
    PubMedGoogle Scholar
  • 2 Kozarek RA. Direct cholangioscopy and pancreatoscopy at time of endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 1988; 83: 55-57
    PubMedGoogle Scholar
  • 3 Neuhaus H. Cholangioscopy. Endoscopy 1992; 24: 125-132
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Siddique I, Galati J, Ankoma-Sey V et al The role of choledochoscopy in the diagnosis and management of biliary tract diseases. Gastrointest Endosc 1999; 50: 67-73
    CrossrefPubMedGoogle Scholar
  • 5 Shim CS, Neuhaus H, Tamada K. Direct cholangioscopy. Endoscopy 2003; 35: 752-758
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Fukuda Y, Tsuyuguchi T, Sakai Y et al Diagnostic utility of peroral cholangioscopy for various bile-duct lesions. Gastrointest Endosc 2005; 62: 374-382
    CrossrefPubMedGoogle Scholar
  • 7 Meenan J, Schoeman M, Rauws E et al A video baby cholangioscope. Gastrointest Endosc 1995; 42: 584-585
    CrossrefPubMedGoogle Scholar
  • 8 Lew RJ, Kochman ML. Video cholangioscopy with a new choledochoscope: a case report. Gastrointest Endosc 2003; 57: 804-807
    CrossrefPubMedGoogle Scholar
  • 9 Itoi T, Osanai M, Igarashi Y et al Diagnostic peroral video cholangioscopy is an accurate diagnostic tool for patients with bile duct lesions. Clin Gastroenterol Hepatol 2010; 8: 934-938
    CrossrefPubMedGoogle Scholar
  • 10 Itoi T, Sofuni A, Itokawa F et al Peroral cholangioscopic diagnosis of biliary-tract diseases by using narrow-band imaging (with videos). Gastrointest Endosc 2007; 66: 730-736
    CrossrefPubMedGoogle Scholar
  • 11 Ueki T, Mizuno M, Ota S et al Carbon dioxide insufflation is useful for obtaining clear images of the bile duct during peroral cholangioscopy (with video). Gastrointest Endosc 2010; 71: 1046-1051
    CrossrefPubMedGoogle Scholar
  • 12 Bretthauer M, Thiis-Evensen E, Huppertz-Hauss G et al NORCCAP (Norwegian colorectal cancer prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy. Gut 2002; 50: 604-607
    CrossrefPubMedGoogle Scholar
  • 13 Bretthauer M, Seip B, Aasen S et al Carbon dioxide insufflation for more comfortable endoscopic retrograde cholangiopancreatography: a randomized, controlled, double-blind trial. Endoscopy 2007; 39: 58-64
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Dellon ES, Hawk JS, Grimm IS et al The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc 2009; 69: 843-849
    CrossrefPubMedGoogle Scholar
  • 15 Maple JT, Keswani RN, Hovis RM et al Carbon dioxide insufflation during ERCP for reduction of postprocedure pain: a randomized, double-blind, controlled trial. Gastrointest Endosc 2009; 70: 278-283
    CrossrefPubMedGoogle Scholar
  • 16 Akhtar N, Jafri W, Mozaffar T. Cerebral artery air embolism following an esophagogastroscopy: a case report. Neurology 2001; 56: 136-137
    CrossrefPubMedGoogle Scholar
  • 17 Siddiqui J, Jaffe PE, Aziz K et al Fatal air and bile embolism after percutaneous liver biopsy and ERCP. Gastrointest Endosc 2005; 61: 153-157
    CrossrefPubMedGoogle Scholar
  • 18 Romberg C. Systemic air embolism after ERCP: a case report and review of the literature (with video). Gastrointest Endosc 2009; 70: 1043-1045
    CrossrefPubMedGoogle Scholar
  • 19 Kennedy C, Larvin M, Linsell J. Fatal hepatic air embolism following ERCP. Gastrointest Endosc 1997; 45: 187-188
    CrossrefPubMedGoogle Scholar
  • 20 Nayagam J, Ho KM, Liang J. Fatal systemic air embolism during endoscopic retrograde cholangio-pancreatography. Anaesth Intensive Care 2004; 32: 260-264
    PubMedGoogle Scholar
  • 21 Katzgraber F, Glenewinkel F, Rittner C et al Fatal air embolism resulting from gastroscopy. Lancet 1995; 346: 1714-1715
    PubMedGoogle Scholar
  • 22 Christl SU, Scheppach W, Peters U et al Cerebral air embolism after gastroduodenoscopy: complication of a duodenocaval fistula. Gastrointest Endosc 1994; 40: 376-378
    CrossrefPubMedGoogle Scholar
  • 23 Huycke A, Moeller DD. Hepatic portal venous gas after colonoscopy in granulomatous colitis. Am J Gastroenterol 1985; 80: 637-638
    PubMedGoogle Scholar
  • 24 Efthymiou M, Raftopoulos S, Antoniochirinos J et al Air embolism complicated by left hemiparesis after direct cholangioscopy with an intraductal balloon anchoring system. Gastrointest Endosc 2011; Epub ahead of print 6 April 2011. DOI: DOI: 10.1016/j.gie.2011.01.038.
    PubMedGoogle Scholar
  • 25 Hawkins IF, Caridi JG. Carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida. Eur Radiol 1998; 8: 391-402
    CrossrefPubMedGoogle Scholar
  • 26 Shaw DR, Kessel DO. The current status of the use of carbon dioxide in diagnostic and interventional angiographic procedures. Cardiovasc Intervent Radiol 2006; 29: 323-331
    CrossrefPubMedGoogle Scholar
  • 27 Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc 2007; 65: 832-841
    CrossrefPubMedGoogle Scholar
  • 28 Larghi A, Waxman I. Endoscopic direct cholangioscopy by using an ultra-slim upper endoscope: a feasibility study. Gastrointest Endosc 2006; 63: 853-857
    CrossrefPubMedGoogle Scholar
  • 29 Moon JH, Ko BM, Choi HJ et al Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol 2009; 104: 2729-2733
    CrossrefPubMedGoogle Scholar
  • 30 Choi HJ, Moon JH, Ko BM et al Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos). Gastrointest Endosc 2009; 69: 935-940
    CrossrefPubMedGoogle Scholar