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Capnographic monitoring for carbon dioxide insufflation during endoscopic mucosal dissection: comparison of transcutaneous and end-tidal capnometers



The use of carbon dioxide (CO2) insufflation during endoscopic procedures is effective in reducing patient discomfort caused by bloating. However, transcutaneous arterial CO2 (PtCO2) monitoring usually is required for safety during long endoscopic procedures. To evaluate a new capnometer for monitoring end-tidal carbon dioxide (EtCO2) concentrations and to compare PtCO2 with EtCO2 measured in the same patient, a prospective comparative study of EtCO2 and PtCO2 values measured simultaneously was designed.


The study enrolled 20 consecutive patients (18 men and two women; mean age, 70.1 years) with upper gastrointestinal neoplasms scheduled for endoscopic submucosal dissection (ESD) using conscious sedation with CO2 insufflation, and EtCO2 and PtCO2 were simultaneously measured by each capnometer. Patient status was evaluated before ESD by the American Society of Anesthesiologists (ASA) physical status classification system, and eight patients were judged as class 1, nine patients as class 2, and three patients as class 3. The exclusion criteria ruled out patients with chronic obstructive pulmonary disease or ASA class 4 or 5 physical status. The correlation between EtCO2 and PtCO2 values and the availability of EtCO2 capnography were investigated.


The mean EtCO2 value during ESD was 34.7 ± 4.5 mmHg, and the mean PtCO2 value was 51.6 ± 2.4 mmHg. There was a statistically significant correlation between EtCO2 and PtCO2 (r = 0.331; P = 0.002). Hypoxic events (<90% oxygen saturation [SpO2]) caused by decreased respiratory rate occurred for 12 patients. In 10 (83%) of 12 events, a significant reduction in EtCO2 was seen before the decrease in SpO2.


The EtCO2 values correlated with the PtCO2 values, and the respiratory monitoring methods allowed earlier detection of hypoxia during ESD with conscious sedation than transcutaneous monitoring. The EtCO2 capnometer was considered to be available for the ESD procedure with the patient under conscious sedation using CO2 insufflation.

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The authors greatly appreciate the excellent technical support from Miss Rika Toma.


Ryusaku Kusunoki, Yuji Amano, Takafumi Yuki, Akihiko Oka, Mayumi Okada, Yasumasa Tada, Goichi Uno, Ichiro Moriyama, Norihisa Ishimura, Shunji Ishihara, and Yoshikazu Kinoshita have no conflicts of interest or financial ties to disclose.

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Correspondence to Yuji Amano.

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An erratum to this article can be found at

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Kusunoki, R., Amano, Y., Yuki, T. et al. Capnographic monitoring for carbon dioxide insufflation during endoscopic mucosal dissection: comparison of transcutaneous and end-tidal capnometers. Surg Endosc 26, 501–506 (2012).

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  • Capnography
  • ESD
  • EtCO2
  • PtCO2