Do alpha-glucosidase inhibitors have the potential to induce portal venous gas? -Two clinical case reports.

We herein report two cases of portal venous gas (PVG) following alpha-glucosidase inhibitor (α-GI) therapy for diabetes mellitus. Anti-diabetic treatment with voglibose was commenced in the first case, while the second case was treated with miglitol. Both patients recovered without intensive treatment after discontinuing the α-GI therapy. α-GI medications may increase internal intestinal tract pressure by releasing carbon dioxide and hydrogen gas, potentially causing pneumatosis cystoides intestinalis (PCI) or PVG. Our experience suggests that α-GI therapy is an important potential cause of portal venous gas that can be treated conservatively.

The usefulness and safety of carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography in elderly patients: a prospective, double-blind, randomized, controlled trial.

BACKGROUND/AIMS: Carbon dioxide (CO2) insufflation has been used in endoscopic retrograde cholangiopancreatography (ERCP). However, its usefulness and safety are controversial in elderly patients. Our aim was to assess the safety and usefulness of CO2 insufflation during ERCP in elderly patients. METHODOLOGY: Between April 2010 and June 2011, a total of 60 patients 75 years old or older, who underwent ERCP, were randomized into the CO2 group (n = 30) and the air group (n = 30). Main outcomes were determined by assessing abdominal symptoms according to the Wong-Baker FACES Pain Rating Scale, calculating the volume of residual gas retention within the intestines on abdominal X-ray quantitatively and observing the cardiopulmonary states. RESULTS: 30 patients in the CO2 group and 30 patients in the air group were analyzed. Abdominal distension (P < 0.01), discomfort (P < 0.01) and nausea (P < 0.01) at 2 hours after ERCP were significantly reduced in the CO2 group. The gas volume scores immediately after ERCP (P < 0.01) and at 2 hours (P < 0.01) were significantly lower in the CO2 group. CONCLUSIONS: CO2 insufflation instead of air insufflation is safe and useful for the prevention of post-ERCP abdominal symptoms in elderly patients.