CO₂ insufflation during single-balloon enteroscopy: a multicenter randomized controlled trial

Background and study aims: Carbon dioxide (CO₂₎ insufflation has previously been shown to have advantages over air insufflation in terms of procedure-related pain and oral insertion depth during double-balloon enteroscopy. The aim of this prospective study was to evaluate the performance of CO₂ vs. air insufflation during single-balloon enteroscopy.

Patients and methods: This study was a randomized European multicenter trial (ClinicalTrials.gov: NCT01524055). Patients and endoscopists were blinded to the type of insufflation gas used. Patient discomfort during and after the procedure was scored using a visual analog scale.

Results: A total of 107 patients were enrolled in the study (52 in the CO₂ group and 55 in the air group). Patient characteristics were comparable in both groups. The mean (± SD) oral intubation depth was not significantly deeper in the CO₂ group vs. the air group (254 ± 80 vs. 238 ± 55 cm; P = 0.726). However, in patients with previous abdominal surgery, oral intubation depth was significantly higher in the CO₂ group compared with the air group (258 ± 84 vs. 192 ± 42 cm; P < 0.05). In patients undergoing SBE via the anal approach, CO₂ showed no significant difference in intubation depth compared with air insufflation (86 ± 67 vs. 110 ± 68 cm; P = 0.155). The diagnostic yield was comparable (CO₂ 67 %; air 73 %). Procedure times, dosage of sedation, and therapeutic interventions did not differ between the two groups. Patients in the CO₂ group reported less pain than those in the air group. 

Conclusions: This study demonstrated an advantage of using CO₂ insufflation during single-balloon enteroscopy in patients with a history of previous abdominal surgery. Overall, single-balloon enteroscopy was a well-tolerated procedure that may benefit from the use of CO₂ insufflation to reduce post-procedural pain.

^* Both authors contributed equally to this work.

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