| Summary: | <p>Abstract</p> <p>Background</p> <p>Endoscopic submucosal dissection (ESD) has typically been performed using air insufflation. Recently, however, insufflation of CO<sub>2</sub> has been increasingly used to avoid complications. This prospective study was designed to compare the CO<sub>2</sub> concentration, intestinal volume, and acid–base balance using the duodenal balloon procedure.</p> <p>Methods</p> <p>From June 2010 to February 2011, we enrolled 44 patients with esophageal or gastric cancer and randomly allocated them into two groups. We compared 22 patients undergoing CO<sub>2</sub>-insufflated ESD with a balloon placed into the duodenal bulb (duodenal balloon group) and 22 patients undergoing regular CO<sub>2</sub>-insufflated ESD (regular group). Three-dimensional computed tomography was performed before and after the procedure to measure intestinal volume. CO<sub>2</sub> concentrations were measured every 10 minutes. The visual analogue system (VAS) scores for postoperative symptoms were recorded, and pH was measured immediately after the procedure. This was a prospective case control study randomized by the sealed envelope method.</p> <p>Results</p> <p>Intestinal CO<sub>2</sub> gas volume before and after ESD was lower in the duodenal balloon group than in the regular group (<it>P</it> = 0.00027). The end-tidal CO<sub>2</sub> level was significantly lower in the duodenal balloon group than in the regular group (<it>P</it> = 0.0001). No significant differences in blood ΔpH were found between the two groups. The VAS score for the occurrence of nausea due to abdominal distension after ESD indicated a significant difference (<it>P</it> = 0.031).</p> <p>Conclusions</p> <p>ESD using the duodenal balloon occlusion method is effective for reduction of post-ESD intestinal CO<sub>2</sub> gas volume, resulting in a lower total amount of CO<sub>2</sub> insufflation during ESD and reducing harmful influences on the human body to some extent.</p>
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