Download PDF
Z Gastroenterol 2012; 50(5): 445-448
DOI: 10.1055/s-0031-1299076
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

CO2 versus Air Insufflation for Private Practice Routine Colonoscopy: Results of a Randomized Double Blind Trial

CO2- versus Luft-Insufflation bei der Koloskopie: Ergebnisse einer randomisierten Studie in der gastroenterologischen Praxis
M. Mayr
1   Private Gastroenterology Office, Berlin, Germany
,
A. Miller
1   Private Gastroenterology Office, Berlin, Germany
,
U. Gauger
1   Private Gastroenterology Office, Berlin, Germany
,
T. Rösch
2   Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

23 November 2011

18 December 2011

Publication Date:
11 May 2012 (online)

Also available at
    Permissions and Reprints

Abstract

Background: Pain and bloating following colonoscopy are an underestimated problem, with 30 − 60 % of patients complaining of such symptoms. The use of CO2 has been shown to significantly decrease pain after colonoscopy in academic hospital-based studies. The aim of the present study was to evaluate whether such an effect can also be seen during private practice routine colonoscopy.

Patients and Methods: In a prospective double-blind randomized trial, one experienced colonoscopist (> 12 000 examinations) used either air or CO2 insufflation for diagnostic or screening colonoscopy in consecutive patients presenting for diagnostic and screening colonoscopy in private practice. Outcome parameters were occurrence and duration of pain and bloating after colonoscopy based on a patient questionnaire.

Results: Of 180 randomized patients, 156 replies were analyzed (43.3 % male, mean age 61.7 ± 9.7 years). There were no significant differences between the two groups with respect to age and sex distribution, indication, sedation, examination times and polypectomy rates. Both pain and abdominal bloating were significantly lower in the CO2 group. Abdominal pain and bloating in the CO2 vs. air group were absent in 84.4 vs. 64.6 % (p = 0.005) and 66.2 vs. 32.9 % (p < 0.001). Moderate/strong symptoms were also significantly lower with CO2.

Conclusions: The use of CO2 appears to be as effective in daily routine in private practice colonoscopy as reported in previous hospital-based studies.

Zusammenfassung

Hintergrund: Schmerzen und Blähungen nach der Koloskopie sind ein unterschätztes Problem aus Patientensicht und kommen in 30 − 60 % vor. Bei Verwendung von CO2 statt Luft zur Insufflation trat dieses Problem in mehreren randomisierten Studien aus klinischen Zentren signifikant weniger häufig auf. Ziel der vorliegenden Studie war es, diesen Effekt auch in der niedergelassenen Praxis zu testen.

Patienten und Methoden: In einer prospektiven, doppelblinden randomisierten Studie wurden von einem sehr erfahrenen Untersucher in der niedergelassenen Praxis (> 12 000 Koloskopien) für alle Koloskopien entweder CO2 oder Luft verwendet. Hauptzielparameter waren Auftreten und Dauer von Schmerzen und Blähungen (Patientenfragebogen) nach der Koloskopie.

Ergebnisse: Von 180 randomisierten Patienten schickten 156 den Fragebogen zurück (43,3 % männlich, mittleres Alter 61,7 ± 9,7 Jahre). Zwischen den Gruppen gab es keine signifikanten Unterschiede in Alters- und Geschlechtsverteilung, Indikation, Sedierung, Untersuchungszeit und Polypektomierate. Sowohl Schmerz als auch Blähungen waren in der CO2-Gruppe signifikant niedriger: Keine Schmerzen bzw. Blähungen traten in 84,4 vs. 64,6 % (p = 0,005) bzw. 66,2 vs. 32,9 % (p < 0,001) auf. Mäßige/starke Symptome waren ebenfalls seltener in der CO2-Gruppe.

Schlussfolgerungen: Auch in der niedergelassenen Praxis hat der Einsatz von CO2 bei der Koloskopie erhebliche Vorteile für die Patienten.

Key words

colorectal adenoma - colorectal carcinoma - irritable colon

Schlüsselwörter

kolorektales Adenom - kolorektales Karzinom - Colon irritabile
 

  • References

  • 1 Cohen LB. Sedation issues in quality colonoscopy. Gastrointest Endosc Clin N Am 2010; 20: 615-627
    CrossrefPubMedSearch in Google Scholar
  • 2 Singh H, Poluha W, Cheung M et al. Propofol for sedation during colonoscopy. Cochrane Database Syst Rev 2008; 4: CD006268
    PubMedSearch in Google Scholar
  • 3 Drossel R, Adler A, Aminalai A et al. How patients feel about screening colonoscopy – results from a large prospective private practice study in Berlin, Germany. (manuscript in preparation)
    PubMed
  • 4 McLachlan SA, Clements A, Austoker J. Patients’ experiences and reported barriers to colonoscopy in the screening context-A systematic review of the literature. Patient Educ Couns 2012; 86: 137-146
    CrossrefPubMedSearch in Google Scholar
  • 5 Becker GL. Prevention of gas explosions in the large bowel during electrosurgery. Surg Gynecol Obstet 1953; 97: 463
    PubMedSearch in Google Scholar
  • 6 Stevenson GW, Wilson JA, Wilkinson J et al. Pain following colonoscopy: elimination with carbon dioxide. Gastrointest Endosc 1992; 38: 564-567
    CrossrefPubMedSearch in Google Scholar
  • 7 Sumanac K, Zealley I, Fox BM et al. Minimizing postcolonoscopy abdominal pain by using CO2) insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO2 delivery system. Gastrointest Endosc 2002; 56: 190-194
    CrossrefPubMedSearch in Google Scholar
  • 8 Bretthauer M, Thiis-Evensen E, Huppertz-Hauss G et al. NORCCAP (Norwegian colorectal cancer prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy. Gut 2002; 50: 604-607
    CrossrefPubMedSearch in Google Scholar
  • 9 Bretthauer M, Hoff G, Thiis-Evensen E et al. Carbon dioxide insufflation reduces discomfort due to flexible sigmoidoscopy in colorectal cancer screening. Scand J Gastroenterol 2002; 3: 1103-1107
    PubMedSearch in Google Scholar
  • 10 Church J, Delaney C. Randomized, controlled trial of carbon dioxide insufflation during colonoscopy. Dis Colon Rectum 2003; 46: 322-326
    CrossrefPubMedSearch in Google Scholar
  • 11 Bretthauer M, Lynge AB, Thiis-Evensen E et al. Carbon dioxide insufflation in colonoscopy: safe and effective in sedated patients. Endoscopy 2005; 37: 706-709
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Wong JC, Yau KK, Cheung HY et al. Towards painless colonoscopy: a randomized controlled trial on carbon dioxide-insufflating colonoscopy. ANZ J Surg 2008; 78: 871-874
    CrossrefPubMedSearch in Google Scholar
  • 13 Riss S, Akan B, Mikola B et al. CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: a randomized controlled trial. Wien Klin Wochenschr 2009; 121: 464-468
    CrossrefPubMedSearch in Google Scholar
  • 14 Uraoka T, Kato J, Kuriyama M et al. CO2 insufflation for potentially difficult colonoscopies: efficacy when used by less experienced colonoscopists. World J Gastroenterol 2009; 15: 5186-5192
    CrossrefPubMedSearch in Google Scholar
  • 15 Lee JG, Vigil H, Leung JW. A randomized controlled trial of total colonic decompression after colonoscopy to improve patient comfort. Am J Gastroenterol 2001; 96: 95-100
    CrossrefPubMedSearch in Google Scholar
  • 16 Steinberg EN, Howden CW. Randomized controlled trial of rectal tube placement for the management of abdominal distension following colonoscopy. Gastrointest Endosc 1997; 46: 444-446
    CrossrefPubMedSearch in Google Scholar
  • 17 Hilzenrat N, Fich A, Odes HS et al. Does insertion of a rectal tube after colonoscopy reduce patient discomfort and improve satisfaction?. Gastrointest Endosc 2003; 57: 54-57
    PubMedSearch in Google Scholar
  • 18 Segnan N, Patnick S, von Karsa L (eds) European guidelines for quality assurance in colorectal cancer screening and diagnosis. Luxembourg: Publications Office of the European Union; 2010 doi:10.2772/1458 – printed version; doi:10.2772/15379 – electronic version
    PubMedSearch in Google Scholar