title: A randomized controlled study comparing carbon dioxide versus normal saline as distension media in diagnostic office hysteroscopy: is the distension with carbon dioxide a problem?
abstract: OBJECTIVE
  To compare two distension media, carbon dioxide (CO2) and saline, with regards to patient discomfort and the adequacy of the panoramic view in diagnostic hysteroscopy by the vaginoscopic approach.
  
  
  METHODS
  Randomized prospective study.
  
  
  METHODS
  Tertiary referral centers for gynecologic care.
  
  
  METHODS
  264 patients randomly allocated to two groups: CO2 (132 women) and normal saline (132 women).
  
  
  METHODS
  Office hysteroscopy performed with a forward-oblique 30° telescope (total diameter 5.1 mm) and CO2 as the distension medium or with a forward-oblique 30° telescope (final diameter 5.1mm) and saline solution as the distension medium.
  
  
  METHODS
  Global operative time, pain experienced by patients using a visual analogue scale (VAS), severity of the pain (VAS), incidence of collateral effects (shoulder-tip pain, nausea, or dizziness), degree of difficulty, and view (VAS).
  
  
  RESULTS
  Pelvic discomfort was comparable between groups, without statistically significant differences in intensity or degree of difficulty. However, the visual quality was statistically significantly higher when hysteroscopy was performed with CO2 as the distension medium.
  
  
  CONCLUSIONS
  No relevant difference in pain or technical difficulty was found between the two distension media, but CO2 was associated with better quality visualization.
authors.affiliation: Diagnostic Hysteroscopy and Resectoscopic Surgery Centre, San Giovanni di Dio Hospital, Frattaminore, Naples, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Raimondo
authors.forename: Diego
authors.initials: D
authors.lastname: Raimondo
authors.forename: Gemma
authors.initials: G
authors.lastname: D'Aniello
authors.forename: Cinzia
authors.initials: C
authors.lastname: Russo
authors.forename: Antonietta
authors.initials: A
authors.lastname: Ronga
authors.forename: Massimo
authors.initials: M
authors.lastname: Gabbanini
authors.forename: Marco
authors.initials: M
authors.lastname: Filippeschi
authors.forename: Felice
authors.initials: F
authors.lastname: Petraglia
authors.forename: Pasquale
authors.initials: P
authors.lastname: Florio
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods; D002245:Carbon Dioxide; D004106:Dilatation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D012965:Sodium Chloride; D014591:Uterine Diseases / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide; D012965:Sodium Chloride