Digestive Diseases Center, Vítkovice Hospital, University of Ostrava, Ostrava, Czech Republic.
Eur J Gastroenterol Hepatol. 2012 Aug;24(8):971-7. doi: 10.1097/MEG.0b013e3283543f16.
Water immersion insertion and carbon dioxide (CO2) insufflation, as alternative colonoscopic 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 colonoscopic techniques.
In a prospective, randomized study, a total of 420 patients were randomized to either water immersion insertion and CO2 insufflation during withdrawal (water/CO2), water 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 outcome was the success of minimal sedation colonoscopy, which was defined as reaching the cecum without switching to another insertion method and without additional sedation beyond the initial 2 mg of midazolam. Patient comfort during and after the procedure was assessed.
A total of 404 patients 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 24 h after the procedure was comparable with that in the CO2/CO2 group and significantly lower than that in the air groups (water/air and air/air). No complications were recorded during the study.
The 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 that in other techniques.
水浸式插入和二氧化碳（CO2）充气作为替代结肠镜检查技术，能够减少患者在检查过程中和检查后的不适。我们评估了水浸式插入和 CO2 充气的联合应用是否在疗效和患者舒适度方面优于其他结肠镜检查技术。
在一项前瞻性、随机研究中，共有 420 名患者被随机分为水浸式插入和 CO2 充气在退镜时（水/CO2）、水插入和空气充气在退镜时（水/空气）、CO2 充气在插入和退镜时（CO2/CO2）或空气充气在插入和退镜时（空气/空气）。主要结局是最小镇静结肠镜检查的成功率，定义为无需切换到另一种插入方法且初始 2 毫克咪达唑仑之外无需额外镇静即可到达盲肠。评估患者在检查过程中和检查后的舒适度。
共分析了 404 名患者。水插入组（水/CO2 和水/空气）的最小镇静结肠镜检查成功率为 97%，而气体插入组（CO2/CO2 和空气/空气）的成功率为 83.3%（P<0.0001）。水/CO2 组术中疼痛和腹胀明显低于其他组。水/CO2 组患者在检查后 24 小时的不适与 CO2/CO2 组相当，明显低于空气组（水/空气和空气/空气）。研究期间未记录到任何并发症。
水浸式插入和 CO2 充气联合应用似乎是一种用于最小镇静结肠镜检查的有效且安全的方法。与其他技术相比，总体患者不适明显减少。
