title: Carbon dioxide insufflation during colonoscopy in inflammatory bowel disease patients: a double-blind, randomized, single-center trial.
abstract: OBJECTIVE
  Bowel distension by insufflated air causes abdominal discomfort after colonoscopy. Carbon dioxide (CO2) instead of air insufflation during colonoscopy can reduce postprocedural discomfort in diagnostic and screening cases. Discomfort after colonoscopy and CO2 insufflation have never been studied in inflammatory bowel disease (IBD) patients, characterized by younger age, structural changes of the colon, and need for repeated and frequently uncomfortable colonoscopies. Our trial was designed to evaluate postprocedural discomfort associated with CO2 compared with air insufflation in unsedated or minimally sedated patients with known IBD.
  
  
  METHODS
  In a double-blind, randomized, single-center study, 64 patients were randomized to either CO2 insufflation (CO2) or air insufflation colonoscopy (Air). Abdominal pain, bloating, and flatulence scores during 24 h after colonoscopy were recorded using a continuous scale of 0-10 (0=none, 10=maximum discomfort). The primary endpoint used for power calculation was bloating score at 1 h after colonoscopy.
  
  
  RESULTS
  Pain, bloating, and flatulence scores at end, 1, and 3 h after colonoscopy were significantly lower in CO2 than in Air arm (P<0.001). Scores at 6, 12, and 24 h were comparable. Procedural parameters such as cecal and terminal ileum intubation rate, intubation and total time, pain during insertion, need for repositioning, and abdominal compression were not different between arms. No complications were recorded in the study.
  
  
  CONCLUSIONS
  Compared with air, CO2 insufflation significantly reduces abdominal pain, bloating, and flatulence scores during at least 3 h after colonoscopy in IBD patients, achieving comparable intraprocedural outcomes.
authors.affiliation: aDigestive Diseases Center, Vítkovice Hospital bDepartment of Internal Medicine, Faculty of Medicine, University of Ostrava, Ostrava cInstitute of Endocrinology, Prague, Czech Republic.
authors.forename: Přemysl
authors.initials: P
authors.lastname: Falt
authors.forename: Vít
authors.initials: V
authors.lastname: Šmajstrla
authors.forename: Petr
authors.initials: P
authors.lastname: Fojtík
authors.forename: Martin
authors.initials: M
authors.lastname: Hill
authors.forename: Ondřej
authors.initials: O
authors.lastname: Urban
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000473:pathology; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology; D018153:Czech Republic; D004311:Double-Blind Method; D005260:Female; D005414:Flatulence / Q000209:etiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007327:Insufflation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives; D002245:Carbon Dioxide