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TOWARDS PAINLESS COLONOSCOPY: A DOUBLE BLIND RANDOMIZED CONTROLLED TRIAL ON CARBON DIOXIDE INSUFFLATION COLONOSCOPY
Author(s) -
Wong J.C.H.,
Yau K.K.,
Cheung H.Y.S.,
Wong D.C.T.,
Chung C.C.,
Li M.K.W.
Publication year - 2007
Publication title -
surgical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.109
H-Index - 10
eISSN - 1744-1633
pISSN - 1744-1625
DOI - 10.1111/j.1744-1633.2007.00349_2.x
Subject(s) - medicine , colonoscopy , randomized controlled trial , insufflation , intubation , visual analogue scale , anesthesia , polypectomy , surgery , complication , colorectal cancer , cancer
Background: Colonoscopy is a useful screening and diagnostic tool. Yet, many patients fear it because of pain. Carbon dioxide (CO 2 ) insufflation during examination was reported to result in reduced pain. However, data on CO 2 insufflation colonoscopy are still limited. Objective: The current study is a randomized controlled trial aiming to assess the safety and potential benefits of CO 2 insufflating colonoscopy. Methods: From January to April 2006, adult patients undergoing elective colonoscopy were recruited and randomized into CO 2 insufflation (CO 2 i) or air insufflation (AIRi) groups. All examinations were performed by either one of the two designated endoscopists. Pain scores during examination and 30 min, 1 h and 2 h after were recorded using a visual analogue scale (VAS). Other outcomes measured included the caecal intubation rate, complication and caecal intubation time, defined as the time required to reach the caecum. By means of questionnaire, patient's satisfaction and acceptance of the endoscopic examination were assessed after the procedure. Results: Over a 4‐month period, 96 patients were recruited and randomized. The age and gender ratio of the groups were matched. The caecal intubation rate was 96% and 98% in the CO 2 i group and the AIRi group, respectively. No complication occurred in the CO 2 i group whereas one patient from the AIRi group developed secondary haemorrhage after polypectomy. Patients in the CO 2 i group had a significantly lower pain score during ( P < 0.01) and 30 min after ( P = 0.02) the examination. Compared to the AIRi group, significantly more patients in the CO 2 i group reported the examination as painless (VAS 0) during the procedure (45% vs 14%, P < 0.01) and 30 min after (70% vs 51%, P = 0.05). In both groups, high satisfaction scores were recorded. Most of the patients (93% for the CO 2 group and 98% for the air group) would accept another colonoscopy if indicated. Again, most of the patients (89% for the CO 2 group and 96% from the air group) would recommend others to have colonoscopy as the method for colonic evaluation. Conclusion: Our data suggest CO 2 that insufflation colonoscopy is safe. Most importantly, compared to conventional air insufflation colonoscopy, it results in significantly less pain during the examination. CO 2 insufflation colonoscopy holds the potential to be a painless screening tool in the community.