Why Carbon Dioxide Is Better than Air for Flexible GI Endoscopic Insufflation

ECRI Institute believes that carbon dioxide (CO2), rather than air, should be the preferred gas used for insufflation during flexible gastrointestinal (GI) endoscopic procedures. The principal reason for this belief is that CO2 has a much higher solubility in blood than air and is much more rapidly dissolved in the event of embolization (Lango et al. 1996, Findlay and Creighton 1911, Moore and Braselton 1940). Therefore, CO2 is less likely than air to produce an embolism large enough to seriously impede blood flow and harm the patient.

To explain our view, we briefly discuss the current practice for flexible GI endoscopic insufflation, the prevalence of air embolism associated with GI insufflation, as well as the mechanism of gas embolisms in general, and provide recommendations to minimize the risk of gas embolism during flexible GI endoscopy. Our recommendations are based on decades of experience in investigating gas embolisms related to various medical technologies, including gas embolisms associated with GI endoscopy.

Although there are endoscopists that use CO2 for GI insufflation, room air is almost universally employed in the United States for this purpose and has been for decades. In response, video endoscopy manufacturers have provided room air insufflation with their endoscopy systems by incorporating air pumps in their video light-source systems. Using air for insufflation during flexible GI endoscopy is ubiquitous and does not breach any recommended practice, practice advisory, standard of practice, standard of care, or industry standard of which we are aware. Although CO2 insufflation is not as prevalent, using it also does not breach any standard, and it has...