Pain following colonoscopy: elimination with carbon dioxide

Stevenson, Giles W.; Wilson, Julie; Wilkinson, Joanne; Norman, Geoff; Goodacre, R.L.

doi:10.1016/s0016-5107(92)70517-3

Cited by 137 publications

(138 citation statements)

References 24 publications

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“…This difference between the present and previous results could be attributed to differences in the degree of conscious sedation (deep vs. moderate) and the speed of recovery of consciousness (late vs. early) [3,4]. Under conditions of no, mild, or moderate conscious sedation, we hypothesize that the GVS and VAS scores would be strongly correlated for endoscopy including ERCP [1][2][3][4], and the superiority of CO 2 insufflation would be more objectively and quantitatively verified by the GVS under these conditions.…”

Section: Discussioncontrasting

confidence: 91%

“…This result was also reported for colonoscopy patients [1,2]. However, a different study reported that there were no advantages of CO 2 insufflation during ERCP in terms of a reduction in symptoms [8].…”

Section: Discussionsupporting

confidence: 62%

“…However, a different study reported that there were no advantages of CO 2 insufflation during ERCP in terms of a reduction in symptoms [8]. The studies that reported the advantages of CO 2 insufflation during endoscopy used VAS scores for abdominal pain and discomfort as indicators of patient suffering after endoscopy [1][2][3][4]. However, differences in VAS scores (for abdominal pain and discomfort) between patients treated with CO 2 and air insufflation after ERCP under deep conscious sedation in Japan have not been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Hypotension was defined as a decrease in systolic blood pressure to <80 mm Hg. Direct measurement of arterial pCO 2 or transcutaneous pCO 2 measurements were not performed, on the basis of the results of previous studies showing that CO 2 insufflation during ERCP or colonoscopy does not lead to an increase in pCO 2 [1][2][3][4]8].…”

Section: Clinical Assessments and End Pointsmentioning

confidence: 99%

See 3 more Smart Citations

Carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography reduces bowel gas volume but does not affect visual analogue scale scores of suffering: a prospective, double-blind, randomized, controlled trial

et al. 2011

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Section: Discussioncontrasting

confidence: 91%

Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Assessments and End Pointsmentioning

confidence: 99%

See 2 more Smart Citations

Carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography reduces bowel gas volume but does not affect visual analogue scale scores of suffering: a prospective, double-blind, randomized, controlled trial

et al. 2011

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“…A pilot study also reported that CO 2 insufflation was safe and effective during colorectal ESD (15). As CO 2 is absorbed faster than air and is rapidly eliminated through the lungs, CO 2 insufflation is expected to reduce residual gas in both the small and large bowels following ESD, and consequently reduce the abdominal symptoms and complications associated with ESD (15,(22)(23)(24)(25)(26)(27)(28)(29)(30). However, to the best of our knowledge, detailed and quantitative examinations evaluating the effects of CO 2 insufflation on residual gas in the gastrointestinal tract following colorectal ESD have not been performed.…”

Section: Introductionmentioning

confidence: 99%

Carbon dioxide insufflation reduces residual gas in the gastrointestinal tract following colorectal endoscopic submucosal dissection

et al. 2018

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Abstract. Quantitative examinations evaluating the effects of CO 2 insufflation on residual gas in the gastrointestinal tract following colorectal endoscopic submucosal dissection (ESD) are lacking. The present study aimed to assess whether CO 2 insufflation could decrease the amount of residual gas in the gastrointestinal tract following ESD in patients with colorectal neoplasms. Computed tomography (CT) was used to objectively examine whether CO 2 insufflation during colorectal ESD reduced residual gas levels in the gastrointestinal tract following ESD. A total of 83 patients who underwent colorectal ESD between January and December 2009 at Gifu University Hospital (Gifu, Japan) were enrolled. Following exclusion of 17 patients with chronic pulmonary dysfunction, 66 patients were randomized into a CO 2 insufflation group (n=34) and an air insufflation group (n=32). The level of residual gas and the presence of transmural and free-air leaks following ESD were evaluated in both groups using CT. Transcutaneous CO 2 tension (PtcCO 2 ) and ESD-related complications were also compared between the groups. CT measurements of the major and minor axes of the cecal lumen, and of the terminal ileum diameter, indicated the level of residual gas following ESD to be significantly reduced in the CO 2 insufflation group compared with the air insufflation group (P<0.001). Neither the incidences of ESD-related complications, including post-procedure hemorrhage and air leak, nor the abnormalities in vital signs differed between the groups. No significant between-group differences were identified in the baseline and peak PtcCO 2 levels during ESD or in the median PtcCO 2 following ESD. In conclusion, CO 2 insufflation during colorectal ESD was effective in reducing residual gas in the gastrointestinal tract following ESD. IntroductionColorectal cancer is among the most prevalent malignancies worldwide, and therefore effective and minimally invasive procedures are required to reduce the incidence rate of this malignancy (1,2). More recently, utilization of colorectal endoscopic submucosal dissection (ESD) as a minimally invasive treatment for en bloc resection of large superficial neoplasms has become a favored method (3). However, the risk of complication is higher than in gastric ESD as the wall of the colon is thin and operability is limited. In addition, colorectal ESD generally requires a long procedure time due to its technical difficulty (4,5). Therefore, a high level of gas enters the colonic lumen. This is associated with aggravation of subjective symptoms, such as abdominal pain, discomfort and distention, and an increased risk of severe problems, including pneumoderma, pneumothorax, abdominal compartment syndrome and air embolism (6)(7)(8)(9)(10)(11)(12)(13)(14).The safety and efficacy of CO 2 insufflation during ESD for lesions of the esophagus and stomach have been demonstrated in several randomized controlled trials (15-21). A pilot study also reported that CO 2 insufflation was safe and effective during colorectal ES...

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Radiology and endoscopy in the pretreatment diagnostic management of colorectal cancer

Stevenson¹

1993

Cancer

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This paper discusses the imaging methods available for the detection and diagnosis of colon cancer, concentrating on endoscopy and barium radiology. Effective utilization of these two methods may be facilitated by using flexible sigmoidoscopy to direct further investigation. There is a need for educational efforts to enhance the performance of endoscopy and barium radiology so that the high standards achieved in some published series are more generally available to patients. New developments in contrast agents will alter rapidly the roles of ultrasound, CT scanning, and magnetic resonance in the investigation and management of colorectal cancer.

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Pain following colonoscopy: elimination with carbon dioxide

Cited by 137 publications

References 24 publications

Carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography reduces bowel gas volume but does not affect visual analogue scale scores of suffering: a prospective, double-blind, randomized, controlled trial

Carbon dioxide insufflation during endoscopic retrograde cholangiopancreatography reduces bowel gas volume but does not affect visual analogue scale scores of suffering: a prospective, double-blind, randomized, controlled trial

Carbon dioxide insufflation reduces residual gas in the gastrointestinal tract following colorectal endoscopic submucosal dissection

Radiology and endoscopy in the pretreatment diagnostic management of colorectal cancer

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