title: The efficacy and safety of carbon dioxide insufflation during colonoscopy with consecutive esophagogastroduodenoscopy in moderately sedated outpatients: a randomized, double-blind, controlled trial.
abstract: OBJECTIVE
  Colonoscopy with consecutive esophagogastroduodenoscopy (CCEGD) can be more convenient than performing each procedure individually. There has been no randomized controlled trial comparing carbon dioxide (CO2) versus air insufflations during CCEGD in sedated patients. CO2 insufflation instead of air during CCEGD may reduce abdominal pain and be more comfortable. We investigated the efficacy and safety of CO2 insufflation during CCEGD in moderately sedated outpatients.
  
  
  METHODS
  This was a randomized, double-blind, controlled trial. A total of 96 outpatients were randomly assigned to the groups of CO2 or air insufflation. Postprocedure pain was assessed using a 0 to 10 visual analogue scale, and the proportion of pain-free patients was compared between the groups. Waist circumferences and end-tidal CO2 (ETCO2) were measured.
  
  
  RESULTS
  Among 96 patients, cecal intubation failed in 2 patients, who were excluded from the analysis. Forty-eight patients in the CO2 and 46 patients in the air group completed the study. There was significant difference between the 2 groups regarding the proportion of pain-free patients 30 minutes after the procedures [air group, 35/46 (76.1%) vs. CO2 group, 44/48 (91.6%)] (P=0.03). However, there was no significant difference in the proportion at 6 and 24 hours after the procedures. The mean increase in waist circumference was greater with air than with CO2 (1.54 vs. 0.18 cm, P<0.001). The ETCO2 measured immediately after the procedures was slightly higher in the CO2 group than in the air group (38.6 vs. 37.2 mm Hg, P=0.02), but the values were within the normal range. No significant adverse events occurred.
  
  
  CONCLUSIONS
  CO2 insufflation during CCEGD reduced postprocedural pain and distension compared with air. It was comfortable and safe to use in moderately sedated outpatients.
authors.affiliation: Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-gu, Busan, Republic of Korea.
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Seo
authors.forename: Tae Oh
authors.initials: TO
authors.lastname: Kim
authors.forename: Min Jae
authors.initials: MJ
authors.lastname: Park
authors.forename: Hyoung Joon
authors.initials: HJ
authors.lastname: Kim
authors.forename: Bong Chul
authors.initials: BC
authors.lastname: Shin
authors.forename: Jae Gon
authors.initials: JG
authors.lastname: Woo
authors.forename: Nae Yun
authors.initials: NY
authors.lastname: Heo
authors.forename: Jongha
authors.initials: J
authors.lastname: Park
authors.forename: Seung Ha
authors.initials: SH
authors.lastname: Park
authors.forename: Sung Yeon
authors.initials: SY
authors.lastname: Yang
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Moon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000009:adverse effects*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000473:pathology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide