Carbon dioxide insufflation reduces number of postprocedure admissions after endoscopic resection of large colonic lesions: a prospective cohort study

Background: Endoscopic resection (ER) for large colonic lesions is a safe and effective outpatient treatment. Postprocedural pain creates concern for perforation and often results in postprocedure admission (PPA). Carbon dioxide (CO2) insufflation has been shown to reduce pain scores after routine colonoscopy, but an influence on more critical outcomes such as PPA has not been shown. Objective: To assess the outcomes of patients undergoing ER for large colonic lesions, comparing those having air versus those having CO2 insufflation. Design: Prospective, observational, cohort study. Setting: Academic, high-volume, tertiary-care referral center. Patients: Consecutive patients referred for ER of sessile colorectal polyps >= 20 mm. Intervention: ER with air or CO2. Main Outcome Measurements: Rates of PPA, technical outcomes, complication rates. Results: ER was performed on 575 lesions >= 20 mm, 228 with CO2 insufflation. Mean lesion size was 36.5 mm. Lesion and patient characteristics were similar in both groups. The use of CO2 was associated with a 62% decrease in the PPA rate from 8.9% to 3.4% (P = .01). This was mainly because of an 82% decrease in PPA for pain from 5.7% to 1.0% (P = .006). There were no significant difference in the rates of complications. Multiple logistical regression was performed. The adjusted odds ratio (OR) of PPA (OR 0.39; 95% confidence interval [CI], 0.16-0.95; P = .04) and PPA for pain (OR 0.18; 95% CI, 0.04-0.78; P = .02) in the CO2 group remained significant. Limitations: Single center, nonrandomized study. Conclusion: CO2 insufflation significantly reduces PPA after ER of large colonic lesions, primarily because of reduced PPA for pain. CO2 insufflation should be routinely used during ER of large colonic lesions. (Gastrointest Endosc 2013;77:90-5.)