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The use of carbon dioxide in gastrointestinal endoscopy

Published:March 03, 2016DOI:https://doi.org/10.1016/j.gie.2016.01.046
      Adequate distension of the GI lumen is required for safe advancement of endoscopes and for careful visualization of the mucosa. Room air, which is widely used for GI luminal distension, possesses the advantages of universal availability and low cost. However, room air is poorly absorbed by the GI tract and is largely evacuated through belching or passage of flatus. To minimize postprocedural abdominal distention, endoscopists commonly suction out as much air as possible after completion of the procedure and immediately before removal of the endoscope. Despite this practice, older studies indicated that 50% of patients reported pain after completion of colonoscopy, with 12% of patients describing the pain as severe, even at 24 hours after the procedure.
      • Stevenson G.W.
      • Wilson J.A.
      • Wilkinson J.
      • et al.
      Pain following colonoscopy: elimination with carbon dioxide.
      Despite improvements in endoscope technology and techniques leading to shorter procedure times with lower amounts of air insufflated, some patients still experience postprocedure pain related to distension. Carbon dioxide (CO2) is rapidly absorbed by the GI mucosa, driving increased interest in its use as an insufflation agent for endoscopic procedures. The ASGE has previously published a Technology Status Evaluation Report on methods of luminal distention, including CO2, for colonoscopy alone.
      • Maple J.T.
      • Banerjee S.
      • Barth B.A.
      • et al.
      ASGE Technology Committee
      Methods of luminal distention for colonoscopy.
      This document discusses CO2 as an insufflation agent for all endoscopic procedures within the GI tract.

      Abbreviations:

      ASGE (American Society for Gastrointestinal Endoscopy), CO2 (carbon dioxide), DBE (double-balloon endoscopy), ESD (endoscopic submucosal dissection), SBE (single-balloon enteroscopy)
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