Gastroscopy Should Come Before Colonoscopy Using CO₂ Insufflation in Same Day Bidirectional Endoscopies: A Randomized...

Area of Science:

• Gastroenterology
• Endoscopy
• Patient Comfort Studies

Background:

• Same-day bidirectional endoscopies, including esophagogastroduodenoscopies (EGD) and colonoscopies, are common.
• The optimal procedural sequence and the impact of insufflation gas (carbon dioxide vs. air) on patient experience are not well-established.

Purpose of the Study:

• To determine the preferred sequence for same-day EGDs and colonoscopies.
• To evaluate the effect of carbon dioxide (CO2) versus air insufflation on patient comfort and satisfaction.

Main Methods:

• A randomized controlled trial involving 200 adult patients undergoing same-day bidirectional endoscopies.
• Patients were assigned to one of four groups based on procedure order (EGD first or colonoscopy first) and insufflation gas (CO2 or air).
• Patient comfort and satisfaction were assessed using validated scales and questionnaires at multiple time points.

Main Results:

• Performing EGD first resulted in significantly lower Midazolam sedation doses (P=0.01).
• No significant differences in patient comfort scores were observed between procedural sequences or insufflation gases during the procedures.
• Patients in the CO2 groups reported significantly less postprocedural bloating and discomfort (P<0.001).

Conclusions:

• The sequence of same-day bidirectional endoscopies impacts sedation requirements but not overall patient comfort or satisfaction.
• An EGD-first approach requires less sedation.
• Carbon dioxide insufflation is associated with reduced postprocedural abdominal discomfort and bloating.