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  • Title: Efficacy of carbon dioxide versus air insufflation according to different sedation protocols during therapeutic endoscopic retrograde cholangiopancreatography: prospective, randomized, double-blind study.
    Author: Lee SJ, Lee TH, Park SH, Lee YN, Jung Y, Choi HJ, Cha SW, Moon JH, Cho YD, Kim SJ.
    Journal: Dig Endosc; 2015 May; 27(4):512-521. PubMed ID: 25625612.
    Abstract:
    BACKGROUND AND AIM: Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) tends to require considerable air insufflation, which results in abdominal pain or distension. We investigated the efficacy of carbon dioxide (CO2 ) compared with air insufflation when using two different sedation protocols in therapeutic ERCP. METHODS: Patients who required therapeutic ERCP were randomly assigned to four groups based on preliminary data: air insufflation with balanced propofol sedation (BPS), air with propofol + opioid sedation (PS), CO2 with BPS, and CO2 with PS. Post-ERCP abdominal pain, distension and nausea by the 10-point visual analogue scale (VAS), and gas volume score (GVS) by the four-point ordinal scale were measured according to the time interval. Overall satisfaction with sedation, sedation efficacy, and complications were also measured. RESULTS: The CO2 with BPS group showed lowest mean VAS score for abdominal pain (immediately after recovery, P = 0.002; and 3 h post-ERCP, P = 0.047) and distension (immediately after recovery, P = 0.018; 3 h post-ERCP, P < 0.01; and 24 h post-ERCP, P = 0.042). Overall satisfaction with sedation was greater in the CO2 with BPS group (P = 0.005). Mean GVS at 2 h and 12 h post-ERCP was significantly lower in the CO2 with BPS group (P < 0.05). There were no significant differences in procedure or sedation-related complications. CONCLUSION: CO2 with BPS showed the lowest VAS score for early abdominal pain, distension and GVS, and had a higher score for overall satisfaction for sedation.
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