Comparison of rectal suction versus rectal tube insertion for reducing abdominal symptoms immediately after unsedated colonoscopy

Background and study aims: Abdominal discomfort and bloating are common symptoms after colonoscopy. We aimed to compare the effects of direct rectal suction with insertion of a rectal tube on reducing abdominal symptoms after unsedated colonoscopy.

Patients and methods: Consecutive patients undergoing colonoscopy were randomized to have direct rectal suction or placement of a rectal tube immediately after colonoscopy. Post-procedure abdominal pain and bloating were measured with a 0 – 100 visual analogue scale. All participants ranked their satisfaction with either direct rectal suction or insertion of a rectal tube.

Results: Abdominal pain and bloating were significantly reduced by direct rectal suction and placement of a rectal tube at 1 minute (both P < 0.05) and 3 minutes (both P < 0.05) after the colonoscopy. Direct rectal suction significantly reduced abdominal pain at 1 minute (P = 0.001) and 3 minutes (P = 0.005) after colonoscopy compared with rectal tube insertion. Bloating was significantly lower in patients with direct rectal suction compared to those with rectal tube insertion at 1 minute (P = 0.03) after colonoscopy. Greater satisfaction was found in patients with direct rectal suction compared to those with rectal tube insertion (P = 0.009).

Conclusion: Direct rectal suction is more effective than rectal tube placement in reducing abdominal symptoms immediately after colonoscopy. Our study suggests that direct rectal suction is useful in providing relief of symptoms when patients are having difficulty expelling air or are experiencing abdominal symptoms following colonoscopy.

• References

• 1 Brandt LJ, Boley SJ, Sammartano R. Carbon dioxide and room air insufflation of the colon. Effects on colonic blood flow and intraluminal pressure in the dog. . Gastrointest Endosc 1986; 32: 324-329
• 2 Zubarik RS, Eisen G, Fleischer DE. Response. Gastrointest Endosc 2000; 52: 704
• 3 Newcomer MK, Shaw MJ, Williams DM et al. Unplanned work absence following outpatient colonoscopy. J Clin Gastroenterol 1999; 29: 76-78
• 4 Hilzenrat N, Fich A, Odes HS et al. Does insertion of a rectal tube after colonoscopy reduce patient discomfort and improve satisfaction?. Gastrointest Endosc 2003; 57: 54-57
• 5 Lee JG, Vigil H, Leung JW. A randomized controlled trial of total colonic decompression after colonoscopy to improve patient comfort. Am J Gastroenterol 2001; 96: 95-100
• 6 Harewood GC, Wright CA, Baron TH. Assessment of patients’ perceptions of bowel preparation quality at colonoscopy. Am J Gastroenterol 2004; 99: 839-843
• 7 Stevenson GW, Wilson JA, Wilkinson J et al. Pain following colonoscopy: elimination with carbon dioxide. Gastrointest Endosc 1992; 38: 564-567
• 8 Steinberg EN, Howden CW. Randomized controlled trial of rectal tube placement for the management of abdominal distension following colonoscopy. Gastrointest Endosc 1997; 46: 444-446
• 9 Hsieh YH, Tseng KC, Lin HJ. Limited low-air insufflation is optimal for colonoscopy. Dig Dis Sci 2010; 55: 2035-2042
• 10 Rabenstein T, Radaelli F, Zolk O. Warm water infusion colonoscopy: a review and meta-analysis. Endoscopy 2012; 44: 940-951