A randomized, controlled, double-blind trial of air insufflation versus carbon dioxide insufflation during ERCP

Background: Visualization during GI endoscopy requires distention of the bowel lumen. Carbon dioxide (CO2) insufflation decreases postprocedure abdominal discomfort and distension after colonoscopy, but there have been few published studies on its use in ERCP. Objective: To assess the safety and efficacy of CO2 insufflation during ERCP. Design: Double-blind, controlled, randomized trial. Setting: Tertiary-care referral center. Patients: This study involved consecutive patients referred for ERCP, excluding those with known CO2 retention or with chronic use of opiate medications. Intervention: Insufflation of CO versus insufflation of air. Main Outcome Measurements: Primary outcomes were abdominal pain assessed on a visual analogue scale and abdominal distension. Secondary outcomes included transcutaneotis CO2 levels (pCO(2)) and procedural complications. Results: We analyzed 74 patients, 38 in the air group and 36 in the CO, group. Pain scores were similar in both groups 1-hour postprocedure (16 vs 11 mm in the CO2 and air groups, respectively; P = .29) as well as over the subsequent 24 hours. There were also no significant differences between groups in abdominal distension or pCO(2) levels. There were 13 patients with complications in the air group and 5 in the CO2 group (P = .04; nominal significance removed by Bonferroni correction), although most complications were minor in nature. Limitations: Single-center study. Conclusion: The use of CO2 for insufflation during ERCP was safe in a tertiary-care referral population. However, use of CO2 during ERCP did not lead to decreased postprocedural pain or less abdominal distension; so its role in this procedure remains in question. NCT00685386 (Gastrointest Endosc 2010;72:68-77.)