Objectives: compare the intensity of pain experienced after colonoscopy with air or with CO 2 and evaluate the safety of CO 2 in colonoscopies performed with moderate/deep sedation.Materials and methods: individuals undergoing ambulatory colonoscopy without exclusion criteria (severe respiratory disease, morbid obesity) were randomized in air or CO 2 group. We recorded different variables prior to, during and upon completion of the colonoscopy, performing monitoring using pulse oximetry and capnography. Each patient rated, using a visual numeric scale, the intensity of post-colonoscopy pain at different moments.Results: 141 individuals in the air group (sex M/F 63/78, age 24-83) and the CO 2 group (sex M/F 59/70, age 24-82). No significant differences existed in the recorded variables in both groups except for the greater number of explorations performed by an endoscopist in training (TE) in the air group compared to those by a more experienced endoscopist (SE). CO 2 in expired air, episodes of oxygen desaturation and of apnoea and dose of propofol, of midazolam were similar in both groups. No episodes of hypercapnea or any complication requiring cardiopulmonary resuscitation measures were recorded. The pain in the air group was significantly higher at 15 minutes and at 1, 3 and 6 hours after the endoscopy, equalising at 24 hours. After multivariant adjustment for type of doctor (TE vs. SE) the differences observed in pain intensity for each group were maintained.Conclusions: a) the use of CO 2 in colonoscopy causes significantly less pain in the first 6 hours after the procedure; b) its use in patients with moderate/deep sedation is safe; and c) performance of the endoscopic technique is not modified, nor are times reduced.

The growing endoscopic activity, both diagnostic and therapeutic, are also globally makes frequent endoscopic complications, perforation being one of the most serious. However, we also have more possibilities for endoscopic resolution of iatrogenic caused. We report the case of a sigmoid perforation during a colonoscopy that was resolved satisfactorily, avoiding surgery, by endoscopic closure with a nitinol clip Ovesco ® . CASE REPORTAn 82-year-old woman was admitted for assessment of iron deficiency after an episode of syncope. She had a surgical history of hiatal hernia repair 20 years earlier (which subsequently relapsed) and hysterectomy. Tumour markers were normal. Gastroscopy confirmed the presence of a hiatal hernia. Colonoscopy under deep sedation with propofol only and CO 2 insufflation revealed no abnormalities in the explored colonic segment. After traversing about 25 cm of the fixed sigmoid colon with difficulty, an iatrogenic perforation occurred. The perforation was immediately noticed and the endoscope was withdrawn, revealing an approximately 12 mm hole 18 cm distal to the anal margin, through which omentum could be seen (Fig. 1) CLINICAL NOTEDíez-Redondo P, Blanco JI, Lorenzo-Pelayo S, de la SernaHiguera C, Gil-Simón P, Alcaide-Suárez N, Pérez-Miranda M. A novel system for endoscopic closure of iatrogenic colon perforations using the Ovesco® clip and omental patch. Rev Esp Enferm Dig 2012;104:550-552. Fig. 1. Endoscopic image of colonic wall perforation, through which an epiploic appendix is visible.

No abstract

No abstract

No abstract