A meta-analysis of carbon dioxide versus room air insufflation on patient comfort and key performance indicators at colonoscopy
Background Carbon dioxide (CO 2 ) has been used as an alternative to air insufflation at endoscopy with good results; however, uptake of the technique has been poor, possibly due to perceived lack of outcome equivalency. This meta-analysis evaluates the effectiveness of CO 2 versus air in reducing p...
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Published in | International journal of colorectal disease Vol. 35; no. 3; pp. 455 - 464 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.03.2020
Springer |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Carbon dioxide (CO
2
) has been used as an alternative to air insufflation at endoscopy with good results; however, uptake of the technique has been poor, possibly due to perceived lack of outcome equivalency. This meta-analysis evaluates the effectiveness of CO
2
versus air in reducing pain post-colonoscopy and furthermore examines other key performance indicators (KPIs) such as sedative use, procedure times and polyp detection rates.
Methods
This meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pubmed, Pubmed Central, Embase and Cochrane Library were searched for randomized studies from 2004 to 2019, reporting outcomes for patients undergoing colonoscopy with air or CO
2
insufflation, who reported pain on a numerical or visual analogue scale (VAS). Results were reported as mean differences (MD) or pooled odds ratios (OR) with 95% confidence intervals (95% CI).
Results
Of 3586 citations, 23 studies comprising 3217 patients were analysed. Patients undergoing colonoscopy with air insufflation had 30% higher intraprocedural pain scores than those receiving CO
2
(VAS 3.4 versus 2.6, MD -0.7, 95% CI − 1.4–0.0,
p
= 0.05), with a sustained beneficial effect amongst those in the CO
2
group at 30 min, 1–2-h and 6-h post procedure (MD − 0.8, − 0.6 and − 0.2, respectively,
p
< 0.001 for all), as well as less distension, bloating and flatulence (
p
< 0.01 for all). There were no differences between the two groups in KPIs such as the sedation required, procedure time, caecal intubation or polyp detection rates.
Conclusions
CO
2
insufflation improves patient comfort without compromising colonoscopic performance. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 |
ISSN: | 0179-1958 1432-1262 |
DOI: | 10.1007/s00384-019-03470-4 |