Tuesday, 2 January 2018

Carbon dioxide insufflation

Gas insufflation is mandatory to ensure good visualisation during colonoscopy. Currently, air is commonly used for this purpose (Janssens et al. 2009). However, significant amounts of air can be retained in the GI tract (Bretthauer et al. 2003) causing pain and discomfort for the patient. Pain associated with colonoscopy has been identified as a major barrier to participation in CRC screening

Randomised trials have shown that carbon dioxide insufflation significantly reduces abdominal pain and discomfort in patients undergoing colonoscopy and flexible sigmoidoscopy (Bretthauer et al. 2002a; Bretthauer et al. 2002b; Sumanac et al. 2002; Church & Delaney 2003; Wong et al. 2008)

Side effects of C02 insufflation were not detected in unsedated patients in two randomised studies identified in the present literature search and involving 350 patients (Bretthauer et al. 2002b; Bretthauer et al. 2005). Slightly elevated end-tidal C02 levels were detected in sedated patients in the latter study, but only 52 sedated patients were included in the study and patients with chronic obstructive pulmonary disease, as well as patients with known C02 retention, were excluded.

Since carbon dioxide is an inert gas that cannot form a combustible mixture with hydrogen and methane, C02 insufflation will avoid the very rare risk of explosion during sigmoidoscopy or colonoscopy

Following incomplete colonoscopy, an alternative examination is frequently required. Provided adequate facilities are available, same-day CT or MRI colonography, or, in appropriate cases, doublecontrast barium enema would be desirable. However, same-day radiologic examination following colonoscopy frequently yields suboptimal quality when air insufflation is used for colonoscopy, due to retained air in the colon. If CO2 insufflation has been used, same-day radiologic imaging is generally feasible with appropriate quality. This avoids the necessity of scheduling the additional radiologic examinations on another day and further colon cleansing (Phaosawasdi et al. 1986; Rodney, Randolph & Peterson 1988)

In light of the above evidence and considerations: 
 Carbon dioxide insufflation is recommended for colonic endoscopic procedures (I - A).Rec 5.31
 Carbon dioxide insufflation should be avoided in patients with COPD, known C02 retention or otherwise reduced pulmonary function (VI - A).

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