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Diagnostic and Therapeutic Endoscopy
Volume 2011, Article ID 378906, 6 pages
http://dx.doi.org/10.1155/2011/378906
Clinical Study

Carbon Dioxide Insufflation in Routine Colonoscopy Is Safe and More Comfortable: Results of a Randomized Controlled Double-Blinded Trial

1Gastroenterologie Wettingen, 5430 wettingen, Switzerland
2Division of Visceral Surgery and Transplantation, Department of Surgery, University of Bern, 3010 Bern, Switzerland
3Department of Gastroenterology and Hepatology, University Hospital Basel, 4031 Basel, Switzerland

Received 13 January 2011; Accepted 8 April 2011

Academic Editor: Jean-Marc Dumonceau

Copyright © 2011 M. Geyer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Many patients experience pain and discomfort after colonoscopy. Carbon dioxide (CO2) can reduce periprocedural pain although air insufflation remained the standard procedure. The objective of this double-blinded, randomized controlled trial was to evaluate whether CO2 insufflation does decrease pain and bloating during and after colonoscopy compared to room air. Methods. 219 consecutive patients undergoing colonoscopy were randomized to either CO2 or air insufflation. Propofol was used in all patients for sedation. Transcutaneous CO2 was continuously measured with a capnograph as a safety parameter. Pain, bloating, and overall satisfaction were assessed at regular intervals before and after the procedure. Results(data are mean ±SD). 110 patients were randomized to CO2 and 109 to room air. The baseline characteristics were similar in both groups. The mean propofol dose was not different between the treatments, as were the time to reach the ileum and the withdrawal time. pCO2 at the end of the procedure was 3 5 . 2 ± 4 . 3  mmHg (CO2 group) versus 3 5 . 6 ± 6 . 0  mmHg in the room air group ( 𝑃 > . 0 5 ). No relevant complication occurred in either group. There was significantly less bloating for the CO2 group during the postprocedural recovery period ( 𝑃 < . 0 0 1 ) and over the 24-hour period ( 𝑃 < . 0 0 1 ). Also, patients with CO2 insufflation experienced significantly less pain ( 𝑃 = . 0 1 4 ). Finally, a higher overall satisfaction ( 𝑃 = . 0 4 ) was found in the CO2 group. Conclusions. This trial provides compelling evidence that CO2 insufflation significantly reduces bloating and pain after routine colonoscopy in propofol-sedated patients. The procedure is safe with no significant differences in CO2 between the two groups.