Prolonged carbon dioxide insufflation under general anesthesia for endoscopic submucosal dissection

Background and study aims: Carbon dioxide (CO2) insufflation for endoscopy has been reported to provide superior recovery and is expected to reduce the risk of serious complications, including air embolism and tension pneumothorax, whereas general anesthesia offers some advantages not found under intravenous sedation. Little is known about the effect of prolonged CO2 insufflation into gastrointestinal tracts on arterial CO2 tension (PaCO2). Here we introduce the use of general anesthesia with CO2 insufflation for esophagogastroduodenal endoscopic submucosal dissection (ESD).