Background
CO2 is rapidly absorbed from the colon and eliminated via the lung. Insufflation of CO2 instead of air during colonoscopy can reduce distention-induced pain.
Objective
This study aimed to evaluate the effects of CO2 insufflation on pain during intubation and extubation and to identify predictors
of pain and discomfort during colonoscope insertion.
Design
Prospective, randomized, controlled trial.
Setting
Single tertiary medical center in Taiwan.
Patients
A total of 193 patients enrolled from September 2010 through June 2011.
Interventions
Colonoscope insertion with either air or CO2 insufflation. CO2 was used for extubation in both groups.
Main Outcome Measurements
The main outcome measurement was pain, recorded on a 10-point visual analog scale
(VAS) for left-sided colonoscope insertion and right-sided colonoscope insertion and
at 1, 3, 6, and 24 hours post-procedure. Colonoscope cecal intubation time and extubation
time, completeness of intubation, and loop formation were also assessed.
Results
CO2 insufflation during colonoscope intubation was used in 98 patients and air in 97
patients. The mean pain scores during intubation were low (2-3) for patients undergoing
air insufflation and were not reduced further in patients receiving CO2. A mean pain score of 0 was reported by both groups for all postprocedure time points.
Multivariate analysis identified sex, loop formation of the sigmoid colon, time to
reach the transverse colon, and requested sedation as factors that significantly affect
VAS pain scores.
Limitations
This study was limited in scope to a single medical center with experienced endoscopists.
Conclusions
We detected no significant benefit to the use of CO2 insufflation compared with air insufflation during intubation for colonoscopy performed
by experienced colonoscopists. The absence of postprocedure pain in both groups supports
previous observations that CO2 insufflation during extubation is effective in reducing postprocedure pain. Female
sex and loop formation were identified as key factors influencing pain scores on colonoscope
insertion. (Clinical trial registration number: TSGHIRB-099-05-081.)
Abbreviations:
BMI (body mass index), IQR (interquartile range), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
September 10,
2012
Received:
May 8,
2012
Footnotes
DISCLOSURE: This study was supported by the research foundation of Tri-Service General Hospitals (TSGH-C99-062). The authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Carbon dioxide insufflation for colonoscopyGastrointestinal EndoscopyVol. 78Issue 5
- PreviewI was interested in the article “Carbon dioxide insufflation does not reduce pain scores during colonoscope insertion in unsedated patients: a randomized, controlled trial.”1 In their study, Chen et al compared carbon dioxide and air insufflation during endoscopic examination and found no benefit of carbon dioxide insufflation in reducing pain.
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