Towards Painless Colonoscopy: A Randomized Controlled Trial on Carbon Dioxide‐insufflating Colonoscopy

Abstract

Insufflation with CO2 during colonoscopy results in less pain during and after the examination. Because of better tolerance, colonoscopy with CO2 insufflation might gain wide acceptance in the community to be used as a screening tool.

Comparison between insufflation with air or carbon dioxide during the colonoscopy in sedated patients with propofol

“…As for the time of cecal intubation and sedation doses used, there was no difference between using CO 2 or air, in agreement with other previously published studies (9,12,14) and in disagreement with others that have reported a lesser cecal intubation time (8,18) or lower doses of midazolam in patients who underwent endoscopic submucosal dissection (22). We also found no differences between groups in terms of time spent in the recovery room after the colonoscopy, which was probably due to the high workload of the nurse in charge of this room.…”

“…Another benefit we observed in our study, although not quantified, was the realization that the patient who had undergone a colonoscopy with CO 2 felt less shame when experiencing less flatulence, which made them have an immediate perception of comfort and tolerance to exploration. Both the decrease in pain experienced and the feeling of shame is likely to have a positive impact on the increasing acceptance of colonoscopy, although this aspect could not be confirmed by studies that tried unsuccessfully to find differences in the percentages of patients who said they were willing to accept a colonoscopy of screening of colorectal cancer in the future, few minutes after undergoing a colonoscopy with CO 2 or air (12,14). Certainty of safety is a fundamental aspect when recommending the use of CO 2 insufflation during a colonoscopy.…”

“…It has been recorded all the values of pO 2 , pCO 2 and HR before, during and after the procedure. We have not found any other published study, since most of them collect data from patients who have not been sedated or have been superficially sedated (6)(7)(8)(9)(10)12,18) or in the case of patients undergoing a colonoscopy with deep sedation using propofol, pCO 2 (14) was not collected.…”

DDW "Cutting Edge" Colonoscopy Techniques 2011 State-of-the-Art Lecture: Warm water infusion/CO2 insufflation for colonoscopy

“…A considerable number of RCT in unsedated or sedated patients summarized in a review of methods of reducing discomfort during colonoscopy 1 and in more recent reports [8][9][10] showed that CO 2 instead of air insufflations decreases pain scores and increases the proportion of patients with no pain after colonoscopy. The mechanism is based on 'rapid' absorption of CO 2 from the lumen, decreasing distention and associated pain.…”

Complications of Colonoscopy

“…It has been also suggested using carbon dioxide, which is rapidly absorbed and excreted through lungs, as an insufflating gas for colonoscopy to reduce these symptoms [54,55]. Also water immersion technique instead of air insufflation has been proposed to reduce these minor events especially in cases of minimal sedation [56] (Leung 2010).…”