Carbon Dioxide Insufflation in Routine Colonoscopy Is Safe and More Comfortable: Results of a Randomized Controlled Double-Blinded Trial

M Geyer,C Beglinger,U Guller

doi:10.1155/2011/378906

M Geyer, C Beglinger + Show 1 more

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https://doi.org/10.1155/2011/378906

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Abstract

Many patients experience pain and discomfort after colonoscopy. Carbon dioxide (CO2) can reduce periprocedural pain although air insufflation remained the standard procedure. The objective of this double-blinded, randomized controlled trial was to evaluate whether CO2 insufflation does decrease pain and bloating during and after colonoscopy compared to room air. Methods. 219 consecutive patients undergoing colonoscopy were randomized to either CO2 or air insufflation. Propofol was used in all patients for sedation. Transcutaneous CO2 was continuously measured with a capnograph as a safety parameter. Pain, bloating, and overall satisfaction were assessed at regular intervals before and after the procedure. Results(data are mean ±SD). 110 patients were randomized to CO2 and 109 to room air. The baseline characteristics were similar in both groups. The mean propofol dose was not different between the treatments, as were the time to reach the ileum and the withdrawal time. pCO2 at the end of the procedure was 35.2 ± 4.3 mmHg (CO2 group) versus 35.6 ± 6.0 mmHg in the room air group (P > .05). No relevant complication occurred in either group. There was significantly less bloating for the CO2 group during the postprocedural recovery period (P < .001) and over the 24-hour period (P < .001). Also, patients with CO2 insufflation experienced significantly less pain (P = .014). Finally, a higher overall satisfaction (P = .04 ) was found in the CO2 group. Conclusions. This trial provides compelling evidence that CO2 insufflation significantly reduces bloating and pain after routine colonoscopy in propofol-sedated patients. The procedure is safe with no significant differences in CO2 between the two groups.

Highlights

Many patients experience pain and discomfort after colonoscopy
In this randomized controlled trial, 219 consecutive patients undergoing colonoscopy in a private Swiss gastroenterology practice were enrolled between April 2008 to June 2008
One hundred and ten patients were randomized to the CO2 group and 109 to the room air group

Summary

Introduction

Many patients experience pain and discomfort after colonoscopy. An explanation for this observation is the retention of gas in the colon, as several liters of air are insufflated during colonoscopy. CO2 insufflation has been routinely used to create the pneumoperitoneum in lapraroscopic surgery. Room air insufflation has remained the standard of care in most endoscopy centres [1]. Preliminary studies indicate that insufflation of carbon dioxide (CO2) may reduce periprocedural pain. CO2 was first recommended 1953 to avoid gas combustion in the colon during electrocoagulation [2]. In 1986, the rapid absorption of CO2 in the colon and minimal interference with colonic circulation were described, minimizing the risk of bowel ischemia [3].

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