Endoscopy 2007; 39(1): 58-64
DOI: 10.1055/s-2006-945036
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Carbon dioxide insufflation for more comfortable endoscopic retrograde cholangiopancreatography: a randomized, controlled, double-blind trial

M.  Bretthauer1 , B.  Seip2 , S.  Aasen3 , M.  Kordal1 , G.  Hoff2 , L.  Aabakken1
  • 1Department of Medicine, Section of Gastroenterology, Rikshospitalet University Hospital, Oslo, Norway
  • 2Department of Medicine, Telemark Hospital, Skien, Norway
  • 3Department of Radiology, Rikshospitalet University Hospital, Oslo, Norway
Further Information

Publication History

submitted 6 January 2006

accepted after revision 1 September 2006

Publication Date:
25 January 2007 (online)

Background and study aims: The effect on abdominal pain of using carbon dioxide (CO2) for insufflation during endoscopic retrograde cholangiopancreatography (ERCP) has not been investigated. The present study aimed to compare CO2 insufflation with standard air insufflation with respect to the pain experienced during and after ERCP. In addition, we investigated the effect of CO2 insufflation on the partial pressure of CO2 (Pco2). Patients and methods: A total of 118 consecutive patients who were undergoing ERCP were randomized to CO2 insufflation or to air insufflation during the procedure. Both the endoscopists and the patients were blinded with regard to the gas used. Patients rated the intensity of pain experienced on a 100-mm visual analogue scale (VAS) during ERCP and at 1 hour, 3 hours, 6 hours, and 24 hours after the procedure. Transdermal Pco2 was measured continuously in all patients during the procedure. Results: Altogether, 116 patients were eligible for analysis, 58 in each treatment group, and 91 patients responded to the questionnaire (78 %). The mean severity of postprocedure pain was significantly reduced in the CO2 group compared with the air group at 1 hour (5 mm vs. 19 mm on the VAS, P < 0.001), at 3 hours (7 mm vs. 21 mm, P < 0.001), at 6 hours (10 mm vs. 22 mm, P = 0.006), and at 24 hours (4 mm vs. 20 mm, P < 0.001) after the procedure. Radiographs taken 5 minutes after the procedure showed that abdominal distension was more pronounced in patients in the air insufflation group. There were no differences in Pco2 values between the two treatment groups. Conclusions: Carbon dioxide insufflation during ERCP significantly reduces postprocedural abdominal pain. No side effects were observed. Carbon dioxide should be the standard gas used for insufflation in ERCP.

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M. Bretthauer, MD

Department of Medicine
Section of Gastroenterology
Rikshospitalet University Hospital

N-0027 Oslo
Norway

Fax: +47-23072410

Email: michael.bretthauer@rikshospitalet.no

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