World Congress at ACG2017

Simultaneous Plenary Session 1C: Endoscopy

18 - Is CO2 Better Than Air for Insufflation During Colonoscopy In Reducing Post-Procedural Pain? A Meta-Analysis of Randomized Controlled Trials

Monday, October 16
4:40 PM - 4:50 PM
Location: Valencia Ballroom D (Level 4)



Category: General Endoscopy       

Ajai S. Rajabalan, MD1, Kamaldeep Singh, MD2, Diwas Shahi1, Sunil D. Paudel, MD1, Venkata Suresh Patthipati, MD1, Thara Vidyasagaran, MD3, Samir Patel, MD, MPH4, Milan Dodig, MD5
1Western Reserve Health Education, Northeast Ohio Medical University, Youngstown, OH; 2Icahn School of Medicine at Mount Sinai (Bronx), Bronx, NY; 3University of Pittsburgh Medical Center, Youngstown, OH; 4Sparks Health System, Fort Smith, AR; 5Gastroenterology Clinic, Warren, OH
Introduction: Insufflation of the intestinal tract is necessary to improve visualization during colonoscopy. The use of carbon dioxide (CO2) as an alternative insufflation gas in comparison to air has been considered as an essential key to improving patients' acceptance in undergoing endoscopic procedures. The patient can suffer from pain during and in the recovery phase following the procedure. We aimed to evaluate the effect of colonoscopy with CO2 insufflation versus air on patient post-procedural pain, with a meta-analysis of published randomized controlled trials (RCTs).

Methods: The literature search was done from electronic databases including Pubmed, Cochrane, and Embase from inception until April 2017. In total, 28 RCTs were isolated of which 17 RCTs measured pain, as an outcome and those articles are included in the study. The relevant data was extracted and statistical analysis was done using Rev Man 5.3.

Results: A total of 17 RCTs measuring procedural pain, immediate post procedural pain and pain in 2 hours were included. Total number of patients were 1693 in the CO2 group and 1677 in the air group. 584 patients in the CO2 group and 829 patients in the air group reported pain during and with 15 minutes after the procedure and the results were statistically significant rate [OR 0.49, 95%CI (0.34, 0.72), p < 0.0002, I2 =79%]. We also found that 472/1484 patients in the CO2 group and 654/1443 patients in the air group reported pain 2 hours after the procedure, which was also statistically significant [OR 0.35, 95%CI (0.22, 0.57), p < 0.0001, I2 =82%].

Discussion: Our large meta-analysis demonstrates a significant difference of insufflation with CO2 versus air colonoscopy in pain that favors CO2, both within 15 minutes and 2 hours post-procedure. We recommend the determinant focus, when choosing CO2 or air, to be on patient comfort on routine use. There are limitations to this study as not all studies demonstrated data/results with patient numbers/proportions in relation to pain and populations involved in the studies were heterogeneous (i.e. screening, consecutive EGD & colonoscopy, or inflammatory bowel disease).

Supported by Industry Grant: No


Forest plot comparing pain during and 15 minutes after colonoscopy using CO2 vs Air for insufflation.
Forest plot comparing pain 30 minutes and 2 hrs after colonoscopy using CO2 vs Air for insufflation.

Citation: . IS CO2 BETTER THAN AIR FOR INSUFFLATION DURING COLONOSCOPY IN REDUCING POST-PROCEDURAL PAIN? A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Program No. 18. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Ajai S. Rajabalan

Resident
Western Reserve Health Education, Northeast Ohio Medical University
Youngstown, Ohio

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