Gastroenterologie
a hepatologie

Combination of water immersion and carbon dioxide insufflation reduces discomfort associated with colonoscopy

Přemysl Falt ^{Orcid.org  1}, Martin Liberda ^{Orcid.org  2}, Vít Šmajstrla ^{Orcid.org  3}, Martin Kliment ^{Orcid.org  4}, Alice Bártková ^{Orcid.org  3}, Josef Tvrdík ^{Orcid.org  5}, Petr Fojtík ^{Orcid.org  3}, Ondřej Urban ^{Orcid.org  6,7}

+ Affiliation
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

Summary

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.

Keywords

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