Background
Endoscopic resection (ER) for large colonic lesions is a safe and effective outpatient
treatment. Postprocedural pain creates concern for perforation and often results in
postprocedure admission (PPA). Carbon dioxide (CO2) insufflation has been shown to reduce pain scores after routine colonoscopy, but
an influence on more critical outcomes such as PPA has not been shown.
Objective
To assess the outcomes of patients undergoing ER for large colonic lesions, comparing
those having air versus those having CO2 insufflation.
Design
Prospective, observational, cohort study.
Setting
Academic, high-volume, tertiary-care referral center.
Patients
Consecutive patients referred for ER of sessile colorectal polyps ≥20 mm.
Intervention
ER with air or CO2.
Main Outcome Measurements
Rates of PPA, technical outcomes, complication rates.
Results
ER was performed on 575 lesions ≥20 mm, 228 with CO2 insufflation. Mean lesion size was 36.5 mm. Lesion and patient characteristics were
similar in both groups. The use of CO2 was associated with a 62% decrease in the PPA rate from 8.9% to 3.4% (P = .01). This was mainly because of an 82% decrease in PPA for pain from 5.7% to 1.0%
(P = .006). There were no significant difference in the rates of complications. Multiple
logistical regression was performed. The adjusted odds ratio (OR) of PPA (OR 0.39;
95% confidence interval [CI], 0.16-0.95; P = .04) and PPA for pain (OR 0.18; 95% CI, 0.04-0.78; P = .02) in the CO2 group remained significant.
Limitations
Single center, nonrandomized study.
Conclusion
CO2 insufflation significantly reduces PPA after ER of large colonic lesions, primarily
because of reduced PPA for pain. CO2 insufflation should be routinely used during ER of large colonic lesions.
Abbreviations:
AMN (advanced mucosal neoplasia), CO2 (carbon dioxide), ER (endoscopic resection), PPA (postprocedure admission), SG (succinylated gelatin)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 06, 2012
Accepted:
June 6,
2012
Received:
March 31,
2012
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 108.
If you would like to chat with an author of this article, you may contact Dr Bourke at [email protected]
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
