Clinical evidence in support of use of carbon dioxide insufflation in colonoscopy: a narrative review

Abstract

Insufflation of the colon is necessary to distend the lumen for exploration. Carbon dioxide (CO2) insufflation instead of air insufflation (AI) has shown conflicting results about decreasing pain or discomfort during the procedure, even when coupled with water immersion or water exchange method of insertion. CO2 insufflation is associated with a reasonably consistent decrease in bloating and pain scores in the post-procedure period. Other advantages are a decrease in toilet use, less incontinence and less flatulence after colonoscopy. No definitive results are available about the effect of CO2 on the need and dosage of sedation medication(s). Association with water-aided methods appears to show promise in decreasing pain during and after the procedure, achieve higher rates of minimally sedated or unsedated colonoscopy, with less postprocedure bloating and flatulence. Further studies are needed to investigate the impact of combining water-aided methods with CO2 on clinically relevant parameters.