Carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography reduces bowel gas volume but does not affect visual analogue scale scores of suffering: a prospective, double-blind, randomized, controlled trial
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概要
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Background: Endoscopic retrograde cholangiopancreatography (ERCP) and related procedures can cause abdominal pain and discomfort. Two clinical trials have indicated, using the visual analogue scale (VAS) score, that CO2 insufflation during ERCP ameliorates the suffering of patients without complications, as compared with air insufflation. However, differences in patient suffering between CO2 and air insufflation after ERCP under deep conscious sedation have not been reported. We focused on the gas volume score (GVS) as an objective indicator of gas volume, and designed a multicenter, prospective, double-blind randomized controlled study with CO2 and air insufflation during ERCP. Methods: Between March 2010 and August 2010, 80 patients who required ERCP were enrolled and evenly randomized to receive CO2 insufflation (CO2 group) or air insufflation (air group). ERCP and related procedures were performed under deep conscious sedation with fentanyl citrate or pethidine and midazolam or diazepam. The GVS was evaluated as the primary endpoint in addition to the VAS score as the secondary endpoint. Results: The GVS after ERCP and related procedures in the CO2 group was significantly lower than that in the air group (0.14 ± 0.06 vs. 0.31 ± 0.11, P < 0.01), as well as the increase in the rate of GVS ([GVS after - GVS before] / [GVS before ERCP and related procedures] x 100) (3.8 ± 5.9 vs. 21.0 ± 11.1%, P < 0.01). VAS scores 3 and 24 hours after ERCP and related procedures were comparable between the CO2 and air groups for abdominal pain, abdominal distension, and nausea. Additionally, VAS scores were not correlated with the GVS. Conclusions: CO2 insufflation during ERCP reduces GVS (bowel gas volume), but not the VAS score of suffering, as compared with air insufflation. Deep and sufficient sedation during ERCP and related procedures is important for the palliation of patients' pain and discomfort.
- Springer-Verlagの論文
著者
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Hirano Satoshi
北海道大学 医学研究科腫瘍外科学分野
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Sugiura Hiroshi
Department Of Surgical Oncology Division Of Cancer Medicine Hokkaido University Graduate School Of M
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Asaka Masahiro
Third Department Of Internal Medicine Hokkaido University Graduate School Of Medicine
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KUWATANI MASAKI
Department of Gastroenterology, Hokkaido University Graduate School of Medicine
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HIRANO SATOSHI
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine
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Maruta Ichiroh
Department Of Hematology And Oncology Hokkaido University Graduate School Of Medicine
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Imamura Masahiro
Department Of Internal Medicine Saiseikai-hita Hospital
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Shirato Hiroki
Keiyukai Sapporo Hospital Sapporo Jpn
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Iwahashi Masahiro
Department Of Internal Medicine Saiseikai-hita Hospital
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Asaka Masahiro
Hokkaido Univ. School Of Medicine Sapporo Jpn
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Kanamori Hiroe
Department Of Gastroenterology And Hematology Hokkaido University Graduate School Of Medicine
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Imamura M
Department Of Internal Medicine Saiseikai-hita Hospital
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Kobayashi Hajime
Fourth Department Of Internal Medicine Obihiro Kosei Hospital
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KUDO Taiki
Department of Gastroenterology, Hokkaido University Graduate School of Medicine
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Haba Shin
Department Of Surgical Oncology Hokkaido University Graduate School Of Medicine
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Yamato Hiroaki
Department Of Gastroenterology Hokkaido University Graduate School Of Medicine
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Asaka M
Department Of Gastroenterology Hokkaido University Graduate School Of Medicine
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Eto Kazunori
Department Of Gastroenterology Hokkaido University Graduate School Of Medicine
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Kudo Taiki
Department Of Gastroenterology Hokkaido University Graduate School Of Medicine
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Ehira Nobuyuki
Department Of Gastroenterology Hokkaido University Graduate School Of Medicine
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Haba Shin
Department Of Gastroenterology Hokkaido University Graduate School Of Medicine
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Hirano Satoshi
Surgical Oncology Hokkaido University Graduate School Of Medicine
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