Carbon dioxide insufflation does not reduce pain scores during colonoscope insertion in unsedated patients: A randomized, controlled trial

Peng-Jen Chen, Chung-Hsien Li, Tien-Yu Huang, Yu-Lueng Shih, Heng-Cheng Chu, Wei-Kuo Chang, Tsai-Yuan Hsieh

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: CO2 is rapidly absorbed from the colon and eliminated via the lung. Insufflation of CO2 instead of air during colonoscopy can reduce distention-induced pain. Objective: This study aimed to evaluate the effects of CO2 insufflation on pain during intubation and extubation and to identify predictors of pain and discomfort during colonoscope insertion. Design: Prospective, randomized, controlled trial. Setting: Single tertiary medical center in Taiwan. Patients: A total of 193 patients enrolled from September 2010 through June 2011. Interventions: Colonoscope insertion with either air or CO2 insufflation. CO 2 was used for extubation in both groups. Main Outcome Measurements: The main outcome measurement was pain, recorded on a 10-point visual analog scale (VAS) for left-sided colonoscope insertion and right-sided colonoscope insertion and at 1, 3, 6, and 24 hours post-procedure. Colonoscope cecal intubation time and extubation time, completeness of intubation, and loop formation were also assessed. Results: CO2 insufflation during colonoscope intubation was used in 98 patients and air in 97 patients. The mean pain scores during intubation were low (2-3) for patients undergoing air insufflation and were not reduced further in patients receiving CO2. A mean pain score of 0 was reported by both groups for all postprocedure time points. Multivariate analysis identified sex, loop formation of the sigmoid colon, time to reach the transverse colon, and requested sedation as factors that significantly affect VAS pain scores. Limitations: This study was limited in scope to a single medical center with experienced endoscopists. Conclusions: We detected no significant benefit to the use of CO2 insufflation compared with air insufflation during intubation for colonoscopy performed by experienced colonoscopists. The absence of postprocedure pain in both groups supports previous observations that CO2 insufflation during extubation is effective in reducing postprocedure pain. Female sex and loop formation were identified as key factors influencing pain scores on colonoscope insertion. (Clinical trial registration number: TSGHIRB-099-05-081.) © 2013 American Society for Gastrointestinal Endoscopy.
Original languageEnglish
Pages (from-to)79-89
Number of pages11
JournalGastrointestinal Endoscopy
Volume77
Issue number1
DOIs
Publication statusPublished - 2013
Externally publishedYes

Fingerprint

Colonoscopes
Insufflation
Carbon Dioxide
Randomized Controlled Trials
Intubation
Pain
Air
Pain Measurement
Colonoscopy
Transverse Colon
Gastrointestinal Endoscopy
Sigmoid Colon
Carbon Monoxide
Visual Analog Scale
Taiwan
Colon
Multivariate Analysis
Clinical Trials
Lung

Keywords

  • BMI
  • body mass index
  • interquartile range
  • IQR
  • VAS
  • visual analog scale
  • carbon dioxide
  • adult
  • article
  • cecum
  • colonoscope
  • colonoscopy
  • controlled study
  • double blind procedure
  • extubation
  • female
  • human
  • intubation
  • major clinical study
  • male
  • outcome assessment
  • postoperative complication
  • postoperative discomfort
  • postoperative pain
  • postoperative period
  • priority journal
  • randomized controlled trial
  • sedation
  • sex difference
  • transverse colon
  • Air
  • Body Mass Index
  • Carbon Dioxide
  • Colonoscopy
  • Conscious Sedation
  • Double-Blind Method
  • Female
  • Humans
  • Insufflation
  • Male
  • Middle Aged
  • Pain
  • Pain Measurement
  • Prospective Studies
  • Sex Factors

Cite this

Carbon dioxide insufflation does not reduce pain scores during colonoscope insertion in unsedated patients: A randomized, controlled trial. / Chen, Peng-Jen; Li, Chung-Hsien; Huang, Tien-Yu; Shih, Yu-Lueng; Chu, Heng-Cheng; Chang, Wei-Kuo; Hsieh, Tsai-Yuan.

In: Gastrointestinal Endoscopy, Vol. 77, No. 1, 2013, p. 79-89.

Research output: Contribution to journalArticle

Chen, Peng-Jen ; Li, Chung-Hsien ; Huang, Tien-Yu ; Shih, Yu-Lueng ; Chu, Heng-Cheng ; Chang, Wei-Kuo ; Hsieh, Tsai-Yuan. / Carbon dioxide insufflation does not reduce pain scores during colonoscope insertion in unsedated patients: A randomized, controlled trial. In: Gastrointestinal Endoscopy. 2013 ; Vol. 77, No. 1. pp. 79-89.
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abstract = "Background: CO2 is rapidly absorbed from the colon and eliminated via the lung. Insufflation of CO2 instead of air during colonoscopy can reduce distention-induced pain. Objective: This study aimed to evaluate the effects of CO2 insufflation on pain during intubation and extubation and to identify predictors of pain and discomfort during colonoscope insertion. Design: Prospective, randomized, controlled trial. Setting: Single tertiary medical center in Taiwan. Patients: A total of 193 patients enrolled from September 2010 through June 2011. Interventions: Colonoscope insertion with either air or CO2 insufflation. CO 2 was used for extubation in both groups. Main Outcome Measurements: The main outcome measurement was pain, recorded on a 10-point visual analog scale (VAS) for left-sided colonoscope insertion and right-sided colonoscope insertion and at 1, 3, 6, and 24 hours post-procedure. Colonoscope cecal intubation time and extubation time, completeness of intubation, and loop formation were also assessed. Results: CO2 insufflation during colonoscope intubation was used in 98 patients and air in 97 patients. The mean pain scores during intubation were low (2-3) for patients undergoing air insufflation and were not reduced further in patients receiving CO2. A mean pain score of 0 was reported by both groups for all postprocedure time points. Multivariate analysis identified sex, loop formation of the sigmoid colon, time to reach the transverse colon, and requested sedation as factors that significantly affect VAS pain scores. Limitations: This study was limited in scope to a single medical center with experienced endoscopists. Conclusions: We detected no significant benefit to the use of CO2 insufflation compared with air insufflation during intubation for colonoscopy performed by experienced colonoscopists. The absence of postprocedure pain in both groups supports previous observations that CO2 insufflation during extubation is effective in reducing postprocedure pain. Female sex and loop formation were identified as key factors influencing pain scores on colonoscope insertion. (Clinical trial registration number: TSGHIRB-099-05-081.) {\circledC} 2013 American Society for Gastrointestinal Endoscopy.",
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author = "Peng-Jen Chen and Chung-Hsien Li and Tien-Yu Huang and Yu-Lueng Shih and Heng-Cheng Chu and Wei-Kuo Chang and Tsai-Yuan Hsieh",
note = "被引用次數:11 Export Date: 22 March 2016 CODEN: GAENB 通訊地址: Hsieh, T.-Y.; Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Road, Neihu District, Taipei City 114, Taiwan; 電子郵件: endoscopy.taipei@gmail.com 化學物質/CAS: carbon dioxide, 124-38-9, 58561-67-4; Carbon Dioxide, 124-38-9 商標: CF-H260AZI, Olympus, Japan; CV-260, Olympus; UCR insufflator, Olympus, Japan 製造商: Olympus, Japan 參考文獻: Lieberman, D.A., Weiss, D.G., Bond, J.H., Use of colonoscopy to screen asymptomatic adults for colorectal cancer Veterans Affairs Cooperative Study Group 380 (2000) N Engl J Med, 343, pp. 162-168; Rex, D.K., Johnson, D.A., Lieberman, D.A., Colorectal cancer prevention 2000: Screening recommendations of the American College of Gastroenterology American College of Gastroenterology (2000) Am J Gastroenterol, 95, pp. 868-877; Paggi, S., Radaelli, F., Amato, A., Unsedated colonoscopy: An option for some but not for all (2012) Gastrointest Endosc, 75, pp. 392-398; Stevenson, G.W., Wilson, J.A., Wilkinson, J., Pain following colonoscopy: Elimination with carbon dioxide (1992) Gastrointest Endosc, 38, pp. 564-567; Bretthauer, M., Thiis-Evensen, E., Huppertz-Hauss, G., NORCCAP (Norwegian colorectal cancer prevention): A randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy (2002) Gut, 50, pp. 604-607; Hussein, A.M., Bartram, C.I., Williams, C.B., Carbon dioxide insufflation for more comfortable colonoscopy (1984) Gastrointest Endosc, 30, pp. 68-70; Sumanac, K., Zealley, I., Fox, B.M., Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: A prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system (2002) Gastrointest Endosc, 56, pp. 190-194; Bretthauer, M., Lynge, A.B., Thiis-Evensen, E., Carbon dioxide insufflation in colonoscopy: Safe and effective in sedated patients (2005) Endoscopy, 37, pp. 706-709; Yamano, H.O., Yoshikawa, K., Kimura, T., Carbon dioxide insufflation for colonoscopy: Evaluation of gas volume, abdominal pain, examination time and transcutaneous partial CO2 pressure (2010) J Gastroenterol, 45, pp. 1235-1240; Liu, X., Liu, D., Li, J., Safety and efficacy of carbon dioxide insufflation during colonoscopy [in Chinese] (2009) Zhong Nan da Xue Xue Bao Yi Xue Ban, 34, pp. 825-829; Martin, J.P., Arlett, P.A., Holdstock, G., Development of a sedation policy for upper GI endoscopy based on an audit of patients' perception of the procedure (1996) Eur J Gastroenterol Hepatol, 8, pp. 355-357; Chen, P.J., Shih, Y.L., Chu, H.C., A prospective trial of variable stiffness colonoscopes with different tip diameters in unsedated patients (2008) Am J Gastroenterol, 103, pp. 1365-1371; Brandt, L.J., Boley, S.J., Sammartano, R., Carbon dioxide and room air insufflation of the colon Effects on colonic blood flow and intraluminal pressure in the dog (1986) Gastrointest Endosc, 32, pp. 324-329; Riss, S., Akan, B., Mikola, B., CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: A randomized controlled trial (2009) Wien Klin Wochenschr, 121, pp. 464-468; Wu, J., Hu, B., The role of carbon dioxide insufflation in colonoscopy: A systematic review and meta-analysis (2012) Endoscopy, 44, pp. 128-136; Wong, J.C., Yau, K.K., Cheung, H.Y., Towards painless colonoscopy: A randomized controlled trial on carbon dioxide-insufflating colonoscopy (2008) ANZ J Surg, 78, pp. 871-874; Shah, S.G., Brooker, J.C., Thapar, C., Patient pain during colonoscopy: An analysis using real-time magnetic endoscope imaging (2002) Endoscopy, 34, pp. 435-440; Shergill, A.K., McQuaid, K.R., Deleon, A., Randomized trial of standard versus magnetic endoscope imaging colonoscopes for unsedated colonoscopy (2012) Gastrointest Endosc, 75, pp. 1031-1036e1; Leung, F.W., Harker, J.O., Jackson, G., A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method (2010) Gastrointest Endosc, 72, pp. 693-700; Radaelli, F., Paggi, S., Amato, A., Warm water infusion versus air insufflation for unsedated colonoscopy: A randomized, controlled trial (2010) Gastrointest Endosc, 72, pp. 701-709; Anderson, J.C., Messina, C.R., Cohn, W., Factors predictive of difficult colonoscopy (2001) Gastrointest Endosc, 54, pp. 558-562; Waye, J.D., Bashkoff, E., Total colonoscopy: Is it always possible? (1991) Gastrointest Endosc, 37, pp. 152-154; Tsai, M.S., Su, Y.H., Liang, J.T., Patient factors predicting the completion of sedation-free colonoscopy (2008) Hepatogastroenterology, 55, pp. 1606-1608; Eckardt, A.J., Swales, C., Bhattacharya, K., Open access colonoscopy in the training setting: Which factors affect patient satisfaction and pain? (2008) Endoscopy, 40, pp. 98-105; Shumaker, D.A., Zaman, A., Katon, R.M., Use of a variable-stiffness colonoscope allows completion of colonoscopy after failure with the standard adult colonoscope (2002) Endoscopy, 34, pp. 711-714",
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TY - JOUR

T1 - Carbon dioxide insufflation does not reduce pain scores during colonoscope insertion in unsedated patients: A randomized, controlled trial

AU - Chen, Peng-Jen

AU - Li, Chung-Hsien

AU - Huang, Tien-Yu

AU - Shih, Yu-Lueng

AU - Chu, Heng-Cheng

AU - Chang, Wei-Kuo

AU - Hsieh, Tsai-Yuan

N1 - 被引用次數:11 Export Date: 22 March 2016 CODEN: GAENB 通訊地址: Hsieh, T.-Y.; Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Road, Neihu District, Taipei City 114, Taiwan; 電子郵件: endoscopy.taipei@gmail.com 化學物質/CAS: carbon dioxide, 124-38-9, 58561-67-4; Carbon Dioxide, 124-38-9 商標: CF-H260AZI, Olympus, Japan; CV-260, Olympus; UCR insufflator, Olympus, Japan 製造商: Olympus, Japan 參考文獻: Lieberman, D.A., Weiss, D.G., Bond, J.H., Use of colonoscopy to screen asymptomatic adults for colorectal cancer Veterans Affairs Cooperative Study Group 380 (2000) N Engl J Med, 343, pp. 162-168; Rex, D.K., Johnson, D.A., Lieberman, D.A., Colorectal cancer prevention 2000: Screening recommendations of the American College of Gastroenterology American College of Gastroenterology (2000) Am J Gastroenterol, 95, pp. 868-877; Paggi, S., Radaelli, F., Amato, A., Unsedated colonoscopy: An option for some but not for all (2012) Gastrointest Endosc, 75, pp. 392-398; Stevenson, G.W., Wilson, J.A., Wilkinson, J., Pain following colonoscopy: Elimination with carbon dioxide (1992) Gastrointest Endosc, 38, pp. 564-567; Bretthauer, M., Thiis-Evensen, E., Huppertz-Hauss, G., NORCCAP (Norwegian colorectal cancer prevention): A randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy (2002) Gut, 50, pp. 604-607; Hussein, A.M., Bartram, C.I., Williams, C.B., Carbon dioxide insufflation for more comfortable colonoscopy (1984) Gastrointest Endosc, 30, pp. 68-70; Sumanac, K., Zealley, I., Fox, B.M., Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: A prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system (2002) Gastrointest Endosc, 56, pp. 190-194; Bretthauer, M., Lynge, A.B., Thiis-Evensen, E., Carbon dioxide insufflation in colonoscopy: Safe and effective in sedated patients (2005) Endoscopy, 37, pp. 706-709; Yamano, H.O., Yoshikawa, K., Kimura, T., Carbon dioxide insufflation for colonoscopy: Evaluation of gas volume, abdominal pain, examination time and transcutaneous partial CO2 pressure (2010) J Gastroenterol, 45, pp. 1235-1240; Liu, X., Liu, D., Li, J., Safety and efficacy of carbon dioxide insufflation during colonoscopy [in Chinese] (2009) Zhong Nan da Xue Xue Bao Yi Xue Ban, 34, pp. 825-829; Martin, J.P., Arlett, P.A., Holdstock, G., Development of a sedation policy for upper GI endoscopy based on an audit of patients' perception of the procedure (1996) Eur J Gastroenterol Hepatol, 8, pp. 355-357; Chen, P.J., Shih, Y.L., Chu, H.C., A prospective trial of variable stiffness colonoscopes with different tip diameters in unsedated patients (2008) Am J Gastroenterol, 103, pp. 1365-1371; Brandt, L.J., Boley, S.J., Sammartano, R., Carbon dioxide and room air insufflation of the colon Effects on colonic blood flow and intraluminal pressure in the dog (1986) Gastrointest Endosc, 32, pp. 324-329; Riss, S., Akan, B., Mikola, B., CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: A randomized controlled trial (2009) Wien Klin Wochenschr, 121, pp. 464-468; Wu, J., Hu, B., The role of carbon dioxide insufflation in colonoscopy: A systematic review and meta-analysis (2012) Endoscopy, 44, pp. 128-136; Wong, J.C., Yau, K.K., Cheung, H.Y., Towards painless colonoscopy: A randomized controlled trial on carbon dioxide-insufflating colonoscopy (2008) ANZ J Surg, 78, pp. 871-874; Shah, S.G., Brooker, J.C., Thapar, C., Patient pain during colonoscopy: An analysis using real-time magnetic endoscope imaging (2002) Endoscopy, 34, pp. 435-440; Shergill, A.K., McQuaid, K.R., Deleon, A., Randomized trial of standard versus magnetic endoscope imaging colonoscopes for unsedated colonoscopy (2012) Gastrointest Endosc, 75, pp. 1031-1036e1; Leung, F.W., Harker, J.O., Jackson, G., A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method (2010) Gastrointest Endosc, 72, pp. 693-700; Radaelli, F., Paggi, S., Amato, A., Warm water infusion versus air insufflation for unsedated colonoscopy: A randomized, controlled trial (2010) Gastrointest Endosc, 72, pp. 701-709; Anderson, J.C., Messina, C.R., Cohn, W., Factors predictive of difficult colonoscopy (2001) Gastrointest Endosc, 54, pp. 558-562; Waye, J.D., Bashkoff, E., Total colonoscopy: Is it always possible? (1991) Gastrointest Endosc, 37, pp. 152-154; Tsai, M.S., Su, Y.H., Liang, J.T., Patient factors predicting the completion of sedation-free colonoscopy (2008) Hepatogastroenterology, 55, pp. 1606-1608; Eckardt, A.J., Swales, C., Bhattacharya, K., Open access colonoscopy in the training setting: Which factors affect patient satisfaction and pain? (2008) Endoscopy, 40, pp. 98-105; Shumaker, D.A., Zaman, A., Katon, R.M., Use of a variable-stiffness colonoscope allows completion of colonoscopy after failure with the standard adult colonoscope (2002) Endoscopy, 34, pp. 711-714

PY - 2013

Y1 - 2013

N2 - Background: CO2 is rapidly absorbed from the colon and eliminated via the lung. Insufflation of CO2 instead of air during colonoscopy can reduce distention-induced pain. Objective: This study aimed to evaluate the effects of CO2 insufflation on pain during intubation and extubation and to identify predictors of pain and discomfort during colonoscope insertion. Design: Prospective, randomized, controlled trial. Setting: Single tertiary medical center in Taiwan. Patients: A total of 193 patients enrolled from September 2010 through June 2011. Interventions: Colonoscope insertion with either air or CO2 insufflation. CO 2 was used for extubation in both groups. Main Outcome Measurements: The main outcome measurement was pain, recorded on a 10-point visual analog scale (VAS) for left-sided colonoscope insertion and right-sided colonoscope insertion and at 1, 3, 6, and 24 hours post-procedure. Colonoscope cecal intubation time and extubation time, completeness of intubation, and loop formation were also assessed. Results: CO2 insufflation during colonoscope intubation was used in 98 patients and air in 97 patients. The mean pain scores during intubation were low (2-3) for patients undergoing air insufflation and were not reduced further in patients receiving CO2. A mean pain score of 0 was reported by both groups for all postprocedure time points. Multivariate analysis identified sex, loop formation of the sigmoid colon, time to reach the transverse colon, and requested sedation as factors that significantly affect VAS pain scores. Limitations: This study was limited in scope to a single medical center with experienced endoscopists. Conclusions: We detected no significant benefit to the use of CO2 insufflation compared with air insufflation during intubation for colonoscopy performed by experienced colonoscopists. The absence of postprocedure pain in both groups supports previous observations that CO2 insufflation during extubation is effective in reducing postprocedure pain. Female sex and loop formation were identified as key factors influencing pain scores on colonoscope insertion. (Clinical trial registration number: TSGHIRB-099-05-081.) © 2013 American Society for Gastrointestinal Endoscopy.

AB - Background: CO2 is rapidly absorbed from the colon and eliminated via the lung. Insufflation of CO2 instead of air during colonoscopy can reduce distention-induced pain. Objective: This study aimed to evaluate the effects of CO2 insufflation on pain during intubation and extubation and to identify predictors of pain and discomfort during colonoscope insertion. Design: Prospective, randomized, controlled trial. Setting: Single tertiary medical center in Taiwan. Patients: A total of 193 patients enrolled from September 2010 through June 2011. Interventions: Colonoscope insertion with either air or CO2 insufflation. CO 2 was used for extubation in both groups. Main Outcome Measurements: The main outcome measurement was pain, recorded on a 10-point visual analog scale (VAS) for left-sided colonoscope insertion and right-sided colonoscope insertion and at 1, 3, 6, and 24 hours post-procedure. Colonoscope cecal intubation time and extubation time, completeness of intubation, and loop formation were also assessed. Results: CO2 insufflation during colonoscope intubation was used in 98 patients and air in 97 patients. The mean pain scores during intubation were low (2-3) for patients undergoing air insufflation and were not reduced further in patients receiving CO2. A mean pain score of 0 was reported by both groups for all postprocedure time points. Multivariate analysis identified sex, loop formation of the sigmoid colon, time to reach the transverse colon, and requested sedation as factors that significantly affect VAS pain scores. Limitations: This study was limited in scope to a single medical center with experienced endoscopists. Conclusions: We detected no significant benefit to the use of CO2 insufflation compared with air insufflation during intubation for colonoscopy performed by experienced colonoscopists. The absence of postprocedure pain in both groups supports previous observations that CO2 insufflation during extubation is effective in reducing postprocedure pain. Female sex and loop formation were identified as key factors influencing pain scores on colonoscope insertion. (Clinical trial registration number: TSGHIRB-099-05-081.) © 2013 American Society for Gastrointestinal Endoscopy.

KW - BMI

KW - body mass index

KW - interquartile range

KW - IQR

KW - VAS

KW - visual analog scale

KW - carbon dioxide

KW - adult

KW - article

KW - cecum

KW - colonoscope

KW - colonoscopy

KW - controlled study

KW - double blind procedure

KW - extubation

KW - female

KW - human

KW - intubation

KW - major clinical study

KW - male

KW - outcome assessment

KW - postoperative complication

KW - postoperative discomfort

KW - postoperative pain

KW - postoperative period

KW - priority journal

KW - randomized controlled trial

KW - sedation

KW - sex difference

KW - transverse colon

KW - Air

KW - Body Mass Index

KW - Carbon Dioxide

KW - Colonoscopy

KW - Conscious Sedation

KW - Double-Blind Method

KW - Female

KW - Humans

KW - Insufflation

KW - Male

KW - Middle Aged

KW - Pain

KW - Pain Measurement

KW - Prospective Studies

KW - Sex Factors

U2 - 10.1016/j.gie.2012.09.012

DO - 10.1016/j.gie.2012.09.012

M3 - Article

VL - 77

SP - 79

EP - 89

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 1

ER -