The use of carbon dioxide as an insufflation agent in barium enema—does it have a role?

Robson, Nicola; Lloyd, Milton S.; Regan, Fintan

doi:10.1259/0007-1285-66-783-197

Cited by 18 publications

(9 citation statements)

References 5 publications

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“…The use of carbon dioxide, rather than air, as an insufflation agent. Our study confirms previous work [2,5,6,7] which shows that the use of CO 2 as a bowel insufflator results in significantly lower pain scores, compared with room air. We therefore recommend its routine use, not only for barium enema, but also for colonoscopy and other pneumocolon techniques.…”

Section: Discussionsupporting

confidence: 92%

“…Differences in mucosal coating/quality of the study between the groups were not assessed, although this has been evaluated elsewhere [5,6].…”

Section: Methodsmentioning

confidence: 99%

“…Several previous studies have shown significant decreases in pain scores reported in barium enema [2,5,6,7], in colonoscopy [3] and in small bowel enema with pneumocolon technique [4], by using CO 2 for bowel insufflation, rather than room air. This has been ascribed to the fact that it is absorbed from the bowel 35 times faster than nitrogen, the main component of room air [8,9]; however, its routine use is cumbersome, with the addition of a reservoir bag to the rectal catheter, and the necessity for continuous and frequent top-ups to maintain colonic distension [2].…”

Section: Introductionmentioning

confidence: 99%

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A double-blind randomised, placebo-controlled trial evaluating the influence of oral long-acting muscle relaxant (Mebeverine MR), and insufflation with CO2 on pain associated with barium enema

et al. 2003

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Previous investigators have shown significant benefit using CO(2) for bowel insufflation. Others have suggested that the long-acting smooth muscle relaxant, Mebeverine, may be of benefit. We subjected this to a randomised double-blind trial. A total of 181 outpatients were randomised to receive either Mebeverine or placebo as pre-medication, and either air or CO(2) for bowel insufflation, thus creating four treatment groups. Visual-analogue lines were used to record pain scores before, during, and up to 8 h following the enema. All groups showed increased pain scores during the enema, with peak pain scores at the end of the examination, falling to baseline scores by 8 h. Patients receiving the combination of C0(2) and placebo had significantly lower pain scores at 1 and 4 h ( P=0.00 and P=0.014, respectively; Kruskal-Wallis test) compared with all other groups. Having Mebeverine as a pre-medication did not significantly lower pain scores compared with placebo, and decreased the amount of benefit received from the CO(2). We confirm that CO(2) is of benefit in decreasing pain during barium enema, and we recommend its routine use to improve the comfort of patients. Mebeverine is not of benefit, and its use as a pre-medication for enemas is not recommended.

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Section: Discussionsupporting

confidence: 92%

“…Differences in mucosal coating/quality of the study between the groups were not assessed, although this has been evaluated elsewhere [5,6].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A double-blind randomised, placebo-controlled trial evaluating the influence of oral long-acting muscle relaxant (Mebeverine MR), and insufflation with CO2 on pain associated with barium enema

et al. 2003

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“…The faster colonic reabsorption (30-100 times faster than room air [26] and thus better acceptance than room air [27,28,29,30]) has been sufficiently proven in studies with double-contrast barium enema, but for this application a sufficient colonic distention is contested [27,31] and therefore may outweigh the advantages in patient acceptability. However, since we did not remove the rectal tube during the examination, additional CO 2 could easily be insufflated by compression on the CO 2 bag if the scout image revealed poor colonic distention.…”

Section: Limitationsmentioning

confidence: 99%

Patient acceptance for CT colonography: what is the real issue?

et al. 2002

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The aim of this study was to evaluate the discomfort associated with CT colonography compared with colonoscopy and bowel purgation cleansing, and to evaluate patient preference between CT colonography and colonoscopy. In a total of 124 patients, scheduled for multidetector virtual CT colonography and diagnostic colonoscopy, patient acceptance and future preference were assessed during the different steps of the procedure (colon preparation, CT examination, and conventional colonoscopy). Patients who described contradictory findings between the degree of discomfort and their preference regarding follow-up examinations were retrospectively reinterviewed regarding the reason for this discrepancy. Colonoscopy was graded slightly more uncomfortable than virtual CT colonography, but the preparation was clearly the most uncomfortable part of the procedure. Concerning their preference regarding follow-up examinations, 71% of the patients preferred virtual CT colonography, 24% preferred colonoscopy, and 5% had no preference. Twenty-eight percent of the patients preferred virtual CT colonography despite that they thought it was equally or even more uncomfortable than colonoscopy. This was mainly due to the faster procedure (17 patients), the lower physical challenge (14 patients), and the lack of sedation (12 patients) of virtual CT colonography. Factors other than the discomfort related to the examinations play an important role in the patient's preference for virtual CT colonography, namely the faster procedure, the lower physical challenge, and the lack of sedation. Since the preparation plays a major decisive factor in the patient acceptance of virtual CT colonography, more attention should be given to fecal tagging.

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“…The use of CO 2 has been shown to both improve distention and reduce post-procedural discomfort over manual room air distention. 8, 15, 16 In addition, the automated nature of CO 2 is strongly preferred by technologists, because the determination of an end point prior to scanning is much more straightforward compared with manual room air distention. 8 …”

Section: Discussionmentioning

confidence: 99%

Performing an additional decubitus series at CT colonography

2010

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Purpose To determine the rate and associated factors for acquiring a decubitus series at CT colonography (CTC), in addition to the standard supine and prone series. Materials and Methods CTC examinations read centrally at one institution but performed at three different centers in 6,380 adults were reviewed to determine the frequency of an additional decubitus series. Results were analyzed according to study indication (primary screening versus diagnostic for incomplete colonoscopy), practice site (academic versus community), patient age, gender, body mass index (BMI), and temporal variation. At all sites, the CT technologist determined the need for an additional decubitus series, with infrequent radiologist input in select cases. Results The frequency for the CT technologist to obtain a decubitus series at screening was 9.7% (578/5952), compared with 22.9% (98/428) following failed colonoscopy (p<0.001). The decubitus rate at the academic center (9.4%, 550/5871) was significantly lower than the community hospitals (34.6% combined, 28/81) (p<0.001). The rate progressively increased with age, from 5.0% under age 50 to 28.0% over age 80. No significant difference was seen between men and women (10.3% versus 9.2%), but a strong correlation existed with increased BMI, rising to >25% for BMI over 40. Marked temporal variation existed at the academic center, with quarterly rates ranging from 0% to 17%. Conclusions The frequency for performing a third series at CTC varies considerably according to indication, practice site, patient age, BMI, and time. These results have important implications for clinical practice, including the need for improved training and feedback for CT technologists.

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The use of carbon dioxide as an insufflation agent in barium enema—does it have a role?

Cited by 18 publications

References 5 publications

A double-blind randomised, placebo-controlled trial evaluating the influence of oral long-acting muscle relaxant (Mebeverine MR), and insufflation with CO2 on pain associated with barium enema

A double-blind randomised, placebo-controlled trial evaluating the influence of oral long-acting muscle relaxant (Mebeverine MR), and insufflation with CO2 on pain associated with barium enema

Patient acceptance for CT colonography: what is the real issue?

Performing an additional decubitus series at CT colonography

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