Endoscopy 2014; 46(01): 53-58
DOI: 10.1055/s-0033-1359041
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Philipp Lenz*
1  Department of Medicine B, University of Münster, Münster, Germany
2  European Institute for Molecular Imaging, University of Münster, Münster, Germany
,
Tobias Meister*
3  Department of Medicine II, Helios Albert-Schweitzer University Teaching Hospital Northeim, Northeim, Germany
,
Mauro Manno
4  Gastroenterology and Digestive Endoscopy Unit, New S. Agostino-Estense Civil Hospital, Baggiovara di Modena, Modena, Italy
,
Marco Pennazio
5  Division of Gastroenterology 2, San Giovanni Battista University Teaching Hospital, Turin, Italy
,
Rita Conigliaro
4  Gastroenterology and Digestive Endoscopy Unit, New S. Agostino-Estense Civil Hospital, Baggiovara di Modena, Modena, Italy
,
Sven Lebkücher
1  Department of Medicine B, University of Münster, Münster, Germany
,
Hansjoerg Ullerich
1  Department of Medicine B, University of Münster, Münster, Germany
,
Andre Schmedt
1  Department of Medicine B, University of Münster, Münster, Germany
,
Martin Floer
3  Department of Medicine II, Helios Albert-Schweitzer University Teaching Hospital Northeim, Northeim, Germany
,
Torsten Beyna
1  Department of Medicine B, University of Münster, Münster, Germany
,
Frank Lenze
1  Department of Medicine B, University of Münster, Münster, Germany
,
Dirk Domagk
1  Department of Medicine B, University of Münster, Münster, Germany
› Author Affiliations
Further Information

Publication History

submitted 28 May 2013

accepted after revision 04 November 2013

Publication Date:
18 December 2013 (online)

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.