Background: Air insufflation is essential in routine colonoscopy, but obtaining optimal insufflation levels has not been discussed in the literature. The aim of this study was to determine optimal air insufflation during colonoscopic examination. Methods: Consecutive patients who underwent colonoscopy were randomized to receive high-air insufflation (group A, n = 83), low-air insufflation (group B, n = 84), or low-air insufflation limited to the rectum and sigmoid colon (group C, n = 83). Completion rate, cecal intubation time, propofol dose, need for abdominal compression, and turning of patients, were evaluated. The post-procedure abdominal bloating was assessed with a 0-10 visual analog scale. Results: The completion rates were similar among the three groups. The cecal intubation time was significantly shorter in group C than in group B (4.1 ± 1.7 min vs. 5.2 ± 3.0 min, mean ± SD, p = 0.005). The dose of propofol was significantly less in group C than in group A (11.7 ± 3.2 mg vs. 12.7 ± 3.6 mg, mean ± SD, p = 0.045). Group C needed the least manual abdominal compression (group A, B, and C: 81.9, 69, and 59%, respectively, p = 0.005) and had the least post-procedure abdominal bloating (group A, B, and C: 2.2 ± 2.4, 2.2 ± 2.1, and 1.5 ± 1.9, respectively, p = 0.04). Conclusions: We found that limited use of low-air insufflation in the rectum and sigmoid is the procedure of choice for colonoscopic examination.
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