Carbon Dioxide Insufflation or Warm-Water Infusion Versus Standard Air Insufflation for Unsedated Colonoscopy

Abstract

Carbon dioxide insufflation was associated with a decrease in the proportion of patients requesting on-demand sedation, improved patient tolerance, and decreased colonoscopy-related pain in comparison with air insufflation. The findings regarding warm-water irrigation confirmed the previously reported advantages, so that warm-water irrigation and carbon dioxide insufflation could represent competitive strategies for colonoscopy in unsedated patients.

Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy

“…It was based on analysis of the pain score (measured on a 100-point visual analogue scale: 0 ¼ no pain; 100 ¼ worst pain) of a report about ondemand sedation colonoscopy using AI, CO 2 insufflation, or WI-AI. 6 The median pain scores were 46 (interquartile range, 22-62) vs 30 (interquartile range, 10-15) vs 28 (interquartile range, 15-50), respectively (P < .01).…”

“…[4][5][6] The description of water-aided methods varies in previously published studies. How these are used in actual practice is unknown.…”

“…1,6 Ten seconds of insufflation were allowed if the endoscopists found it necessary to advance the colonoscope because the lumen could not be seen clearly. 1,6 If more than 3 insufflation episodes were recorded the procedure was considered an assignedmethod failure. 1,6 Water exchange involved infusion and suction of water during insertion to minimally distend the lumen.…”

“…1,6 If more than 3 insufflation episodes were recorded the procedure was considered an assignedmethod failure. 1,6 Water exchange involved infusion and suction of water during insertion to minimally distend the lumen. If the lumen did not open, the instrument was retracted slightly and the infusion started again.…”

Unsedated colonoscopy: an option for some but not for all

“…However, previous data from our group showed that an unsedated colonoscopy can be completed successfully and with a good tolerability in more than 80% of patients willing to undergo an unsedated examination. 8,19 Third, we did not use a validated psychological score to precisely measure the anxiety level of patients by using detailed scores. However, the study aimed to provide practical tools to identify patients willing to undergo unsedated colonoscopy.…”