Efficacy of carbon dioxide versus air insufflation according to different sedation protocols during therapeutic endoscopic retrograde cholangiopancreatography: Prospective, randomized, double-blind study

초록

Background and AimTherapeutic 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. MethodsPatients 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. ResultsThe CO2 with BPS group showed lowest mean VAS score for abdominal pain (immediately after recovery, P=0.002; and 3h post-ERCP, P=0.047) and distension (immediately after recovery, P=0.018; 3h post-ERCP, P<0.01; and 24h post-ERCP, P=0.042). Overall satisfaction with sedation was greater in the CO2 with BPS group (P=0.005). Mean GVS at 2h and 12h 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. ConclusionCO(2) 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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