Combination of water immersion and carbon dioxide insufflation reduces discomfort associated with colonoscopy
Přemysl Falt1, Martin Liberda2, Vít Šmajstrla3, Martin Kliment4, Alice Bártková3, Josef Tvrdík5, Petr Fojtík3, Ondřej Urban6,7
1 II. interní klinika – gastroenterologická a geriatrická, LF UP a FN Olomouc
2 Gastroenterologická ambulance, Nemocnice Valašské Meziříčí, a. s.
3 Centrum péče o zažívací trakt, Vítkovická nemocnice a. s., Ostrava
4 Gastroenterologie und Hepatologie, Klinik für Innere Medizin, Vivantes Klinikum Spandau, Berlin, Germany 2 Research Institute AGEL, Digestive Disease Center, Vitkovice Hospital, Ostrava, Czech Republic
5 Přírodovědecká fakulta. Ostravská univerzita, Ostrava
6 II. interní klinika – gastroenterologie a geriatrie LF UP a FN Olomouc
7 Katedra interních oborů, LF UK v Hradci Králové
Design: Water immersion insertion and carbon dioxide (CO2) insufflation as alternative colonoscopy techniques are able to reduce patient discomfort during and after the procedure. We assessed whether the combination of water immersion and CO2 insufflation is superior in efficacy and patient comfort to other colonoscopy techniques.
Methods: In a prospective study, a total of 420 patients were randomized to either water immersion insertion and CO2 insufflation during withdrawal (Water/CO2), water immersion insertion and air insufflation during withdrawal (Water/Air), CO2 insufflation during both insertion and withdrawal (CO2/CO2), or air insufflation during both insertion and withdrawal (Air/Air). The main objective pursued was the success of minimal sedation colonoscopy which was defined as reaching the caecum without switching to another insertion method and without additional sedation beyond the initial 2 mg of midazolam. In addition, patient comfort during and after the procedure was assessed.
Results: A total of 404 subjects were analyzed. The success rate of minimal sedation colonoscopy in the water insertion arm (Water/CO2 and Water/Air) was 97% compared with 83.3% in the gas insertion arm (CO2/CO2 and Air/Air) (p < 0.0001). Intraprocedural pain and bloating were significantly lower in the Water/CO2 group than in all other groups. Patient discomfort in the Water/CO2 group during the 24 hours after the procedure was comparable with CO2/CO2 and significantly lower than in the air groups (Water/Air and Air/Air). There were no complications recorded in the study.
Conclusion: A combination of water immersion and CO2 insufflation appears to be an effective and safe method for minimal sedation colonoscopy. Overall patient discomfort was significantly reduced compared with other techniques.
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