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

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

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