Carbon Dioxide Insufflation Increases Colonoscopic Adenoma Detection Rate Compared With Air Insufflation

Mills, Christopher D.; McCamley, Chere; Swan, Michael P.

doi:10.1097/mcg.0000000000001003

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…We reported that the ADR was significantly higher in an L-menthol group compared to a placebo group (60.2 vs. 42.6%; p = 0.0083) [15]. There is a report suggesting that CO 2 I was associated with the higher ADR than with AI [27]. To our knowledge, there have been no previous reports on the ADRs by colonoscopy with intracolonic L-mentholS with CO 2 I.…”

Section: Sample Size Calculationmentioning

confidence: 73%

“…It was reported that CO 2 I was associated with the equivalent ADR compared with AI from 16 randomized controlled trials, of which indications of colonoscopy were mainly screening [29]. Although there is a report suggesting CO 2 I was significantly associated with the higher ADR than AI, in this retrospective study, only expert performed colonoscopy and patients undergoing a screening colonoscopy, a surveillance colonoscopy after a post-endoscopic resection of colorectal neoplasms or a colonoscopy for the investigation of positive results of a fecal occult blood test screening, per rectum bleeding, iron deficiency anemia or abdominal pain were eligible for enrollment [27]. This study showed that L-mentholS didn't improve the ADR although we observed that spraying L-menthol was associated with the improvement of colonic peristalsis and the ADR [15].…”

Section: Discussionmentioning

confidence: 99%

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Effects of L-Menthol and Carbon Dioxide on the Adenoma Detection Rate during Colonoscopy: L-Menthol and Carbon Dioxide on Colonoscopy

Inoue¹,

Okuda²,

Oka³

et al. 2019

Digestion

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Background and Aims:We examined the efficacy of the combined use of L-menthol spraying (L-mentholS) as an antispasmodic agent and carbon dioxide insufflation (CO 2 I) on the adenoma detection rate (ADR) in a prospective, singlecenter trial with a 2 × 2 factorial design. Methods: We randomly assigned 611 patients scheduled to undergo colonoscopy to 4 groups: (1) the L-mentholS + CO 2 I (n = 153), (2) L-mentholS + air insufflation (AI; n = 156), (3) CO 2 I (n = 153), and (4) AI (n = 149) groups. We used 20 mL of 0.8%-L-menthol solution for the L-mentholS. The primary outcome was the difference in the ADR, and the secondary outcomes were the differences in colonic peristalsis and abdominal pain. Results: The ADRs were not different among the groups: 1/2/3/4; 39.9%/43.6%/41.2%/51.0%. CO 2 I was associated with a significant decrease in the ADR (OR 0.57; 95% CI 0.35-0.93) with a multiple logistic regression. The interaction between L-mentholS and CO 2 I was associated with a suppression of the decrease in the ADR. Both L-mentholS and CO 2 I were associated with a significant decrease in abdominal pain, and L-mentholS was associated with a significant improvement of peristalsis. Conclusions: The fact that CO 2 I was associated with significant decreases in the ADR was a problem. The combined use of L-mentholS and CO 2 I could help to suppress the decrease in the ADR.

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Section: Sample Size Calculationmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Effects of L-Menthol and Carbon Dioxide on the Adenoma Detection Rate during Colonoscopy: L-Menthol and Carbon Dioxide on Colonoscopy

Inoue¹,

Okuda²,

Oka³

et al. 2019

Digestion

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“…The cecum intubation rate was comparable between the CO 2 and Air groups (100% [43/43] vs. 97.9% [47/48]; p = 0.34). The CO 2 and Air groups did not differ significantly regarding the cecal intubation time (median [IQR]; 7 [ 8 ] min vs. 6 [ 6 ] min, respectively; p = 0.11), total procedure time (22 [ 16 ] min vs. 24 [ 13 ] min, respectively; p = 0.66), or in years of experience of the endoscopists performing the colonoscopies (7 [ 6 ] years vs. 7 [ 5 ] years, respectively; p = 0.62) ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, a prospective RCT showed that employing CO 2 insufflation rather than air insufflation caused less post-procedural abdominal pain and bloating at least 3 h after colonoscopy in patients with IBD [ 12 ]. Regarding the quality of endoscopy, CO 2 insufflation has been reported to increase the adenoma detection rate, a clinical indicator of colonoscopic performance [ 13 ]. However, CO 2 insufflation has not been widely used, and air insufflation remains the major method of insufflation for colonoscopy globally, except for some developed countries [ 12 , 14 ], which is because CO 2 insufflation requires a CO 2 insufflator and supply of CO 2 gas, and is thus more expensive [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Carbon dioxide insufflation reduces the relapse of ulcerative colitis after colonoscopy: A randomized controlled trial

Otake-Kasamoto,

Shinzaki,

Hiyama

et al. 2023

PLoS ONE

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Background and aim Colonoscopy is necessary for diagnosing and surveilling patients with ulcerative colitis, though it may cause disease flares. Colonoscopy with carbon dioxide (CO2) insufflation decreases abdominal discomfort; however, its effect on exacerbation incidence in ulcerative colitis remains unclear. Therefore, this study aimed to evaluate the colonoscopy effects using CO2 insufflation in patients with ulcerative colitis. Methods Overall, 96 remissive patients with ulcerative colitis (partial Mayo score ≤ 2) who underwent total colonoscopy between March 2015 and December 2019 at Osaka University Hospital were enrolled and blindly randomized to the CO2 (n = 45) and air (n = 51) insufflation group (UMIN-CTR, number: UMIN000018801). The post-procedural abdominal discomfort and the clinical relapse (partial Mayo score ≥ 3) rate within 8 weeks were evaluated. Results Baseline backgrounds did not differ between the groups. The mean abdominal fullness and pain scores were significantly lower in the CO2 group than in the Air group immediately (p = 0.0003, p = 0.0003) and 30 min (p < 0.0001, p < 0.0001) after colonoscopy. While the overall clinical relapse rate remained unchanged between the groups, the clinical relapse rate at 8 weeks after colonoscopy was significantly lower in the CO2 group than in the Air group in patients not in complete remission (Mayo endoscopic subscore ≥ 1, p = 0.049; or partial Mayo score ≥ 1, p = 0.022). Conclusions CO2 insufflation can reduce abdominal discomfort in remissive patients with ulcerative colitis and decrease clinical relapse at 8 weeks after colonoscopy for those not in complete remission.

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Key factors for improving adenoma detection rate

Gubbiotti

Spadaccini

Badalamenti

et al. 2022

Expert Review of Gastroenterology & Hepatology

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Carbon Dioxide Insufflation Increases Colonoscopic Adenoma Detection Rate Compared With Air Insufflation

Cited by 4 publications

References 31 publications

Effects of L-Menthol and Carbon Dioxide on the Adenoma Detection Rate during Colonoscopy: L-Menthol and Carbon Dioxide on Colonoscopy

Effects of L-Menthol and Carbon Dioxide on the Adenoma Detection Rate during Colonoscopy: L-Menthol and Carbon Dioxide on Colonoscopy

Carbon dioxide insufflation reduces the relapse of ulcerative colitis after colonoscopy: A randomized controlled trial

Key factors for improving adenoma detection rate

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