CARBON DIOXIDE INSUFFLATION DURING ENDOSCOPIC RESECTION OF LARGE COLORECTAL POLYPS CAN REDUCE POST-PROCEDURE ABDOMINAL PAIN

Aims:

Compared to air insufflation, carbon dioxide (CO₂) insufflation reduces abdominal pain after endoscopic procedures. However, studies of the use of CO₂ insufflation during endoscopic resection of large colorectal polyps (LCPs) are lacking. This study evaluated the impact of CO₂ insufflation on pain after endoscopic resection of LCPs.

Methods:

In a prospective randomized controlled trial (RCT), 132 patients were randomly assigned to groups that underwent endoscopic resection with CO₂ insufflation (CO₂ group, n = 66) or air insufflation (air group, n = 66). The primary outcome was abdominal pain post-procedure (PP), recorded using a visual analogue scale (VAS). The secondary outcomes were abdominal distension, rates of technical success, amounts of sedatives prescribed, use of analgesics, and adverse events.

Results:

Baseline patient characteristics were similar between the groups. The mean VAS score for abdominal pain was 12.3 in the CO₂ group vs. 17.5 in the air group at 1h PP (P= 0.047), 9.0 vs. 11.2 at 3h PP (P= 0.440), 4.2 vs. 6.9 at 6h PP (P= 0.307), and 1.6 vs. 3.1 at 24h PP (P= 0.294). At 1h PP, no pain was reported by 41.9% of patients in the CO₂ group vs. 19.7% in the air group (P= 0.008). The secondary outcomes were not significantly different between the two groups.

Conclusions:

The results of this RCT demonstrate the superiority of CO₂ insufflation for endoscopic resection of LCPs in terms of decreasing PP abdominal pain.