Painless Colonoscopy: Available Techniques and Instruments

Hyun Gun Kim, Hyun Gun Kim

Abstract

During colonoscopy, air insufflation to distend the lumen and facilitate careful inspection and scope insertion can induce pain and cause discomfort. Carbon dioxide (CO2) insufflation can decrease abdominal pain and discomfort during and after colonoscopy. The advantage of CO2 insufflation is the rapid absorption of the gas across the intestine. Another painless option is water-assisted colonoscopy. Two methods for water-assisted colonoscopy are available: water immersion and water exchange. In a recent direct comparison, the water exchange method was superior to water immersion, CO2 insufflation, and air insufflation with respect to pain during colonoscopy, although it still had the disadvantage of being a time-consuming procedure. Cap-assisted colonoscopy is a simple technique involving the use of a small transparent cap attached to the tip of the scope. Three studies showed an advantage of this technique in terms of reduced patient discomfort compared with the conventional method. Three robotic colonoscopy systems (Endotics System [Era Endoscopy], NeoGuide [NeoGuide Systems Inc.], and Invendoscope [Invendo Medical]) have been introduced to evaluate pain reduction during colonoscopy, but none has been widely adopted and used in practice. In this review, clinical trials of several techniques and new devices for painless colonoscopy are described and summarized.

Keywords: CO2 insufflation; Colonoscopy; Water-assisted colonoscopy.

Conflict of interest statement

The author has no financial conflicts of interest.

References

    1. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31–53.
    1. GE Technology Assessment Committee. Maple JT, Banerjee S, et al. Methods of luminal distention for colonoscopy. Gastrointest Endosc. 2013;77:519–525.
    1. Saltzman HA, Sieker HO. Intestinal response to changing gaseous environments: normobaric and hyperbaric observations. Ann N Y Acad Sci. 1968;150:31–39.
    1. Hussein AM, Bartram CI, Williams CB. Carbon dioxide insufflation for more comfortable colonoscopy. Gastrointest Endosc. 1984;30:68–70.
    1. Dellon ES, Hawk JS, Grimm IS, Shaheen NJ. The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc. 2009;69:843–849.
    1. Wu J, Hu B. The role of carbon dioxide insufflation in colonoscopy: a systematic review and meta-analysis. Endoscopy. 2012;44:128–136.
    1. Wang WL, Wu ZH, Sun Q, et al. Meta-analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy. Aliment Pharmacol Ther. 2012;35:1145–1154.
    1. Memon MA, Memon B, Yunus RM, Khan S. Carbon dioxide versus air insufflation for elective colonoscopy: a meta-analysis and systematic review of randomized controlled trials. Surg Laparosc Endosc Percutan Tech. 2016;26:102–116.
    1. Bretthauer M, Lynge AB, Thiis-Evensen E, Hoff G, Fausa O, Aabakken L. Carbon dioxide insufflation in colonoscopy: safe and effective in sedated patients. Endoscopy. 2005;37:706–709.
    1. Chen PJ, Li CH, Huang TY, et al. Carbon dioxide insufflation does not reduce pain scores during colonoscope insertion in unsedated patients: a randomized, controlled trial. Gastrointest Endosc. 2013;77:79–89.
    1. Falchuk ZM, Griffin PH. A technique to facilitate colonoscopy in areas of severe diverticular disease. N Engl J Med. 1984;310:598.
    1. Baumann UA. Water intubation of the sigmoid colon: water instillation speeds up left-sided colonoscopy. Endoscopy. 1999;31:314–317.
    1. Church JM. Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective. Gastrointest Endosc. 2002;56:672–674.
    1. Leung JW, Mann S, Leung FW. Options for screening colonoscopy without sedation: a pilot study in United States veterans. Aliment Pharmacol Ther. 2007;26:627–631.
    1. Leung FW, Aharonian HS, Leung JW, Guth PH, Jackson G. Impact of a novel water method on scheduled unsedated colonoscopy in U.S. veterans. Gastrointest Endosc. 2009;69(3 Pt 1):546–550.
    1. Pohl J, Messer I, Behrens A, Kaiser G, Mayer G, Ell C. Water infusion for cecal intubation increases patient tolerance, but does not improve intubation of unsedated colonoscopies. Clin Gastroenterol Hepatol. 2011;9:1039–1043. e1.
    1. Cadoni S, Falt P, Gallittu P, et al. Water exchange is the least painful colonoscope insertion technique and increases completion of unsedated colonoscopy. Clin Gastroenterol Hepatol. 2015;13:1972–1980. e1-e3.
    1. Brocchi E, Pezzilli R, Tomassetti P, Campana D, Morselli-Labate AM, Corinaldesi R. Warm water or oil-assisted colonoscopy: toward simpler examinations? Am J Gastroenterol. 2008;103:581–587.
    1. Park SC, Keum B, Kim ES, et al. Usefulness of warm water and oil assistance in colonoscopy by trainees. Dig Dis Sci. 2010;55:2940–2944.
    1. Leung CW, Kaltenbach T, Soetikno R, Wu KK, Leung FW, Friedland S. Water immersion versus standard colonoscopy insertion technique: randomized trial shows promise for minimal sedation. Endoscopy. 2010;42:557–563.
    1. Hsieh YH, Lin HJ, Tseng KC. Limited water infusion decreases pain during minimally sedated colonoscopy. World J Gastroenterol. 2011;17:2236–2240.
    1. Hsieh YH, Tseng KC, Hsieh JJ, Tseng CW, Hung TH, Leung FW. Feasibility of colonoscopy with water infusion in minimally sedated patients in an Asian Community Setting. J Interv Gastroenterol. 2011;1:185–190.
    1. Radaelli F, Paggi S, Amato A, Terruzzi V. Warm water infusion versus air insufflation for unsedated colonoscopy: a randomized, controlled trial. Gastrointest Endosc. 2010;72:701–709.
    1. Leung JW, Mann SK, Siao-Salera R, et al. A randomized, controlled comparison of warm water infusion in lieu of air insufflation versus air insufflation for aiding colonoscopy insertion in sedated patients undergoing colorectal cancer screening and surveillance. Gastrointest Endosc. 2009;70:505–510.
    1. Leung FW, Harker JO, Jackson G, et al. A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method. Gastrointest Endosc. 2010;72:693–700.
    1. Leung J, Mann S, Siao-Salera R, et al. A randomized, controlled trial to confirm the beneficial effects of the water method on U.S. veterans undergoing colonoscopy with the option of on-demand sedation. Gastrointest Endosc. 2011;73:103–110.
    1. Leung FW, Leung JW, Mann SK, Friedland S, Ramirez FC. The water method significantly enhances patient-centered outcomes in sedated and unsedated colonoscopy. Endoscopy. 2011;43:816–821.
    1. Hsieh YH, Koo M, Leung FW. A patient-blinded randomized, controlled trial comparing air insufflation, water immersion, and water exchange during minimally sedated colonoscopy. Am J Gastroenterol. 2014;109:1390–1400.
    1. Leung FW. Water-aided colonoscopy. Gastroenterol Clin North Am. 2013;42:507–519.
    1. Rabenstein T, Radaelli F, Zolk O. Warm water infusion colonoscopy: a review and meta-analysis. Endoscopy. 2012;44:940–951.
    1. Leung FW, Amato A, Ell C, et al. Water-aided colonoscopy: a systematic review. Gastrointest Endosc. 2012;76:657–666.
    1. Garborg K, Kaminski MF, Lindenburger W, et al. Water exchange versus carbon dioxide insufflation in unsedated colonoscopy: a multicenter randomized controlled trial. Endoscopy. 2015;47:192–199.
    1. Falt P, Liberda M, Smajstrla V, et al. Combination of water immersion and carbon dioxide insufflation for minimal sedation colonoscopy: a prospective, randomized, single-center trial. Eur J Gastroenterol Hepatol. 2012;24:971–977.
    1. Amato A, Radaelli F, Paggi S, Baccarin A, Spinzi G, Terruzzi V. Carbon dioxide insufflation or warm-water infusion versus standard air insufflation for unsedated colonoscopy: a randomized controlled trial. Dis Colon Rectum. 2013;56:511–518.
    1. Tumino E, Sacco R, Bertini M, Bertoni M, Parisi G, Capria A. Endotics system vs colonoscopy for the detection of polyps. World J Gastroenterol. 2010;16:5452–5456.
    1. Cosentino F, Tumino E, Passoni GR, Morandi E, Capria A. Functional evaluation of the endotics system, a new disposable self-propelled robotic colonoscope: in vitro tests and clinical trial. Int J Artif Organs. 2009;32:517–527.
    1. Eickhoff A, van Dam J, Jakobs R, et al. Computer-assisted colonoscopy (the NeoGuide Endoscopy System): results of the first human clinical trial (“PACE study”) Am J Gastroenterol. 2007;102:261–266.
    1. Groth S, Rex DK, Rösch T, Hoepffner N. High cecal intubation rates with a new computer-assisted colonoscope: a feasibility study. Am J Gastroenterol. 2011;106:1075–1080.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner