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Endoscopists should consider risks when using carbon dioxide insufflation in children

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CHICAGO — Despite some advantages, using carbon dioxide for endoscopic insufflation comes with a few safety concerns, according to research presented at the NASPGHAN Annual Meeting.

Chinenye R. Dike, MD, of the University of Nebraska Medical Center, said that while CO2 has been used for many years in adult GI, air has been the standard in pediatrics.

“We do know that there is compelling adult data on CO2 use for a variety of procedures, for colonoscopy, upper endoscopy and even advanced procedures,” she said in her presentation. “But what about using it in children?”

Previous studies have shown less discomfort and less patient-reported bloating when using CO2 in pediatric patients, while none of them showed a reduction in abdominal girth.

Researchers enrolled 178 patients for 180 procedures in a randomized control trial to determine if CO2 is as safe and effective as air for endoscopic insufflation. They randomly assigned patients to undergo endoscopy with CO2 insufflation (n = 91) or air insufflation (n = 89).

Both groups had a similar mix of colonoscopies and upper endoscopies and had similar demographics.

Researchers found that unlike results from past studies, there was no difference between groups in abdominal discomfort or girth from baseline between the two groups. A higher percentage of patients in the CO2 group had no pain at baseline and, therefore, had no pain after they woke up from the procedure.

More patients in the CO2 group had transient hypercarbia during upper endoscopy (34% vs. 4%; P .0001). However, fewer patients in the CO2 group experienced post-procedural bloating and flatulence compared with the air group.

“This result suggests possible risk associated with CO2 insufflation for upper endoscopy, especially when there is no airway protection,” Dike said. “This risk should be balanced with its potential benefits in certain procedures.” – by Alex Young

Reference:

Dike C, et al. Abstract 436. Presented at: NASPGHAN Annual Meeting; Oct. 18-19, 2019; Chicago.

Disclosures: Dike reports no relevant financial disclosures.