CO(2) insufflation for potentially difficult colonoscopies: efficacy when used by less experienced colonoscopists

Abstract

Aim: To clarify the effectiveness of CO(2) insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists.

Methods: One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO(2) or standard air insufflation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist (EC) group and a less experienced colonoscopist (LEC) group. Study measurements included a 100-mm visual analogue scale (VAS) for patient pain during and after colonoscopy examinations, in addition to insertion to the cecum and withdrawal times.

Results: Examination times did not differ, however, VAS scores in the CO(2) group were significantly better than in the air group (P < 0.001, two-way ANOVA) from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group (P = 0.29), however, VAS scores for CO(2) insufflation were significantly better than air insufflation in the LEC group (P = 0.023) immediately after colonoscopies and up to 4 h afterwards.

Conclusion: CO(2) insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.

2009 The WJG Press and Baishideng. All rights reserved.

Figures

Figure 1

Patient flow chart.

Figure 2

Mean VAS scores at corresponding measurement points during and after colonoscopy examinations in CO2 and air insufflation groups. VAS scores for CO2 insufflation were significantly better than those for air insufflation (dP < 0.001, ANOVA for repeated measures). aP < 0.05, bP < 0.01 vs the CO2 group at each measurement point by Wilcoxon rank sum test. VAS: Visual analogue scale.

Figure 3

Mean VAS scores at corresponding measurement points during and after colonoscopy examinations for experienced colonoscopists (EC group) in CO2 and air insufflation groups. There were no significant differences in VAS scores between the two insufflation groups for EC group (P = 0.29, ANOVA for repeated measures).

Figure 4

Mean VAS scores at corresponding measurement points during and after colonoscopy examinations for less experienced colonoscopists (LEC group) in CO2 and air insufflation groups. VAS scores for CO2 insufflation were significantly better compared to air insufflation for LEC group (dP = 0.023, ANOVA for repeated measures). aP < 0.05, bP < 0.01 vs the CO2 group at each measurement point by Wilcoxon rank sum test.