Combination of water immersion and carbon dioxide insufflation for minimal sedation colonoscopy

Abstract

Objective Water immersion insertion and carbon dioxide (CO 2 ) insufflation, as alternative colonoscopic techniques, are able to reduce patient discomfort during and after the procedure. We assessed whether the combination of water immersion and CO 2 insufflation is superior in efficacy and patient comfort to other colonoscopic techniques.Methods In a prospective, randomized study, a total of 420 patients were randomized to either water immersion insertion and CO 2 insufflation during withdrawal (water/ CO 2 ), water insertion and air insufflation during withdrawal (water/air), CO 2 insufflation during both insertion and withdrawal (CO 2 /CO 2 ), or air insufflation during both insertion and withdrawal (air/air). The main outcome was the success of minimal sedation colonoscopy, which was defined as reaching the cecum without switching to another insertion method and without additional sedation beyond the initial 2 mg of midazolam. Patient comfort during and after the procedure was assessed.Results A total of 404 patients were analyzed. The success rate of minimal sedation colonoscopy in the water insertion arm (water/CO 2 and water/air) was 97% compared with 83.3% in the gas insertion arm (CO 2 /CO 2 and air/air; P < 0.0001). Intraprocedural pain and bloating were significantly lower in the water/CO 2 group than in all other groups. Patient discomfort in the water/CO 2 group during 24 h after the procedure was comparable with that in the CO 2 /CO 2 group and significantly lower than that in the air groups (water/air and air/air). No complications were recorded during the study. ConclusionThe combination of water immersion and CO 2 insufflation appears to be an effective and safe method for minimal sedation colonoscopy. Overall patient discomfort was significantly reduced compared with that in other techniques. Eur J Gastroenterol Hepatol 24:971-977 c

Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies

“…Our search identified 155 publications. Seventeen RCTs [2][3][4][5][6][9][10][11][17][18][19][20][21][33][34][35][36] were included in the analysis (41 arms of treatment, 10,350 patients; 55.7% male patients; Supplementary Figs. 1 and 2, available online at www.…”

“…1 Numerous randomized controlled trials (RCTs) described WAC and refined what is meant by the terms WI and WE. [2][3][4][5][6][7][8][9][10][11] Accordingly, WE is a standardized technique developed to achieve gasless colonoscope insertion, substituting through infusion and near-simultaneous suction of water all colon content with a layer of clear water, allowing instrument progression to the cecum. This technique minimizes distension-related pain and maximizes colon cleanliness during insertion to increase the ease of withdrawal inspection.…”

“…On the other hand, WI is an unstandardized technique in which water is infused to facilitate cecal intubation. [2][3][4][5][6] WI does not entail suction removal of all dirty water, residual air, and feces during insertion and has been deemed too cumbersome and time-consuming. [2][3][4] Indeed, when judged to be safe, colonoscope insertion is done also in opaque water and/or air compartment.…”

“…16 When analyzed separately, compared with gas insufflation colonoscopy (air [AI]) or CO 2 , the impact of WI and WE on ADR differs. 1 WI achieved inconsistent results, [2][3][4][5][6]10 whereas WE has been shown to consistently increase ADR, [17][18][19] also in the right side of the colon. 10,20 However, these observations originated from studies with small sample sizes or with adenoma detection as a secondary outcome.…”

Single-port thoracoscopic surgery for pneumothorax under two-lung ventilation with carbon dioxide insufflation

“…This technique was well-tolerated in most patients in our series (22). However, some other series reported potential complications including CO 2 embolism and hypotension resulting from impaired venous returns (36). Stopping the gas infusion and relieving the pneumothorax can promptly reverse hypercarbia and hypoxia.…”