S0293 Co2 Insufflation vs Air Insufflation for Elective Colonoscopy at Two Reference Centers in Ecuador

Abstract

INTRODUCTION: Insufflation of the intestinal tract, usually with room air, is necessary to improve visualization during colonoscopy. Pain and abdominal discomfort are usual complaints associated mainly with the use of air insufflation However, most patients complain of bowel distension and abdominal pain afterwards. Recently, carbon dioxide (CO2) rather than air insufflation has been used. The aim was to evaluate the efficacy, safety, and comfort of colonoscopy CO2 over air for insufflation. METHODS: Prospective analytical cohort study from July 2018 to February 2020, 876 colonoscopy examinations were randomized into two groups according to the gas insufflation used: Air Group (n = 460) and CO2 Group (n = 416). RESULTS: The Air and CO2 Groups were similar in respect to bowel preparation evaluated using the Boston scale, no statistically significant differences related to reasons for examination, presence or intensity of pain at the time of the procedure, age, gender, previous surgery, maneuvers necessary for the advancement of the device, and presence of polyps, tumors or signs of diverticulitis, sedation dosage, complications. The relative risk (RR) of immediate pain is 4.6 times higher when insufflation is done with air instead of CO2 (RR = 4.6; 95% CI: 3.2–8.1; P < 0.001). The risk of abdominal distension in the air group was 2.4 times higher than that of the group insufflated with CO2 (RR = 2.4; 95% CI: 1.6–3.9; P < 0.001). CONCLUSION: The use of CO2 is better than air as it avoids post-examination bloating, improves tolerance to colonoscopy, reducing pain and flatulence out to 6 hours following the procedure, without any additional adverse reactions, warranting routine clinical use.