Post 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 patients’ daily 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.

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.

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