Carbon dioxide insufflation is superior to air insufflation during endoscopic retrograde cholangiopancreatography: A randomized trial

Background: Carbon dioxide (CO2) insufflation has been shown to be superior to air insufflation in colonoscopy, and double balloon enteroscopy. However, the value of CO2 insufflation in endoscopic retrograde cholangiopancreatography (ERCP) is not established. This study aims to assess the efficacy and safety of CO2 insufflation during ERCP. Materials and Methods: Consecutive patients referred for ERCP at a single center were randomized to either air or CO2 insufflation during ERCP. The primary objectives were a post-ERCP abdominal pain (measured by 10 cm visual analog scale [VAS] 30 and 90 min, and 3 h and 24 h after ERCP). Secondary objectives included end-tidal CO2 (ETCO2) values and procedural complications. Results: We randomized 298 patients; 149 into air group and 149 into CO2 group. The VAS score for pain was higher in the air group compared to the CO2 group at 30 min, with a median of 1 (interquartile range 1–0) versus median of 1 (interquartile range 1–0); P = 0.031 and 90 min after the procedure with a median of 0 (interquartile range 1–0) versus median of 0 (interquartile range 0–0); P = 0.006. There were no serious adverse events, and the ETCO2 was within normal limits in both groups. Conclusions: CO2 insufflation is superior to air insufflation during ERCP with regard to patient pain and discomfort and warrants wide adoption. Clinical Trials.gov registration number NCT 01321203.