Impact of carbon dioxide insufflation and water exchange on postcolonoscopy outcomes

Cadoni edited headshotPost written by Sergio Cadoni from the Digestive Endoscopy Unit at St. Barbara Hospital in Iglesias, Italy.

Water exchange (WE) is the least painful insertion method during colonoscopy. However, its impact on postcolonoscopy discomfort has not been well-described. Carbon dioxide (CO2) insufflation has been consistently shown to decrease postcolonoscopy discomfort. We compared postcolonoscopy outcomes of various combinations of insertion and withdrawal techniques (insertion-withdrawal modality: WE-CO2; WE-air insufflation, WE-AI; and CO2-CO2) to ascertain which would be the best combination in terms of reduction of insertion and postcolonoscopy discomfort-pain.

Comfort during and after colonoscopy are major issues influencing patient tolerance and acceptance. Patients experiencing any adverse event, even minor, are less often positive about the entire colonoscopy experience, and less willing to repeat the procedure.

WE-CO2 was the most effective technique in decreasing pain during the procedure and bloating and other procedural outcomes after colonoscopy, and was associated with a significant decrease in interference with patientsdaily activities the same day of the examination. CO2 insufflation did not reduce pain during colonoscopy. Real-time maximum insertion pain score were, mean (95% CI): WE-CO2, 3.1 (2.7-3.7); WE-AI, 3.3 (2.7-3.9); CO2-CO2, 4.7 (4.1-5.3). Post-colonoscopy bloating and pain scores are reported in Figure 1 and Figure 2.

Cadoni Image 1 & 2

Figure 1                                                      Figure 2

Compared with WE-AI, the magnitude of differences produced by WE-CO2 in outcomes after colonoscopy was small; patient satisfaction with the procedure and willingness to repeat it were unaffected and impact on daily activities was limited. Hence, at centers without a CO2 insufflator, patients undergoing WE-AI may have a “colonoscopy experience” similar to WE-CO2.

Find the article abstract here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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