Related Experiment Video
Updated: May 22, 2025
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled
Ajay Aravind1, Ujjal Poddar1, Anshu Srivastava1
1Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
Carbon dioxide (CO2) insufflation during pediatric colonoscopy reduces pain and is safer than room air, though it may increase procedure time. This method is effective without raising concerns for CO2 retention.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Patient Safety
Background:
- Limited powered studies exist on pediatric colonoscopy.
- Reports indicate a risk of carbon dioxide (CO2) retention post-colonoscopy in children.
Purpose of the Study:
- To evaluate the safety and efficacy of CO2 insufflation versus room air in pediatric colonoscopy.
- To assess post-procedural pain and identify potential risks associated with CO2 use.
Main Methods:
- Prospective randomized clinical trial involving 200 children (ages 5-18) undergoing colonoscopy.
- Randomization to CO2 or room air insufflation.
- Primary outcome: post-procedural pain (Visual Analog Scale); Secondary outcomes: cecal intubation time, procedure duration, abdominal distension, end-tidal CO2.
Main Results:
- CO2 group showed significantly lower pain scores at 2 and 4 hours post-procedure.
- Higher proportion of children in the room-air group reported significant pain (VAS ≥3).
- CO2 insufflation led to longer cecal intubation times and total procedure duration, particularly in trainees, but no CO2 retention signs were observed.
Conclusions:
- CO2 insufflation is a safer and less painful alternative to room air for pediatric colonoscopy.
- While procedure time may increase, especially for trainees, CO2 use does not elevate the risk of retention.
- CO2 insufflation offers improved patient comfort without compromising safety.
Background:
Adequately powered studies in children are scarce and there are reports on the risk of carbon dioxide (CO2) retention after colonoscopy.
Purpose:
This study investigated the efficacy and safety of CO2 insufflation in children undergoing colonoscopy.
Methods:
This prospective randomized clinical trial was conducted at a tertiary care hospital between March 2023 and July 2024. We recruited 200 consecutive children (age, 5-18 years; n=100 in each arm) who underwent colonoscopy under conscious sedation. Patients were randomized to receive CO2 or room air using a random number table. The primary outcome measure was postprocedural pain assessed by using a visual analogue scale (VAS). Secondary outcome measures included time to reach the cecum, total procedure duration, abdominal distension, and end-tidal (ET) CO2 level. Complications were recorded.
Results:
Pain scores at 2 and 4 hours postprocedure were significantly lower in the CO2 versus room-air group (1.12 vs. 1.66, P=0.001 at 2 hours and 0.37 vs. 0.61, P=0.002 at 4 hours). The time to reach the cecum was significantly higher in the CO2 group (39.6 vs. 26.6 min, P=0.01). A greater proportion of children in the room-air group (29% vs. 19%, P=0.04) reported significant pain (VAS score, ≥3). The subgroup analysis revealed a significantly longer time to reach the cecum and total procedure duration in the CO2 group among first-year trainees. ET-CO2 levels were significantly higher in the CO2 group (36 [interquartile range, 35-37] mmHg vs. 34 [interquartile range, 32-35] mmHg, P=0.001), but none developed any signs of CO2 retention. No significant intergroup differences were noted in abdominal girth, bloating sensation, analgesic requirements, or procedure-related complications.
Conclusions:
CO2 insufflation is safer and makes the procedure less painful but slower than room-air insufflation, especially in first-year trainees, without an increased risk of retention.
Related Concept Videos
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this...
01:25Endoscopic Procedures II: Colonoscopy
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...