Chaubal Alisha, Pandey Vikas, Patel Ruchir, Poddar Prateik, Phadke Aniruddha, Ingle Meghraj, Sawant Prabha
Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.
Intest Res. 2018 Apr;16(2):299-305. doi: 10.5217/ir.2018.16.2.299. Epub 2018 Apr 30.
BACKGROUND/AIMS: This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation).
Patients with body mass index (BMI) less than 18 kg/m or more than 30 kg/m, or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation.
The primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation (<0.001). The mean pain scores were 5.17, 4.72, and 3.93 on the VAS for air, carbon dioxide, and water insufflation (<0.001). The cecal intubation rate or procedure time did not differ significantly between the 3 groups.
Water insufflation was superior to air or carbon dioxide for pain tolerance. This was seen in the subgroups with BMI <18 kg/m and the post-surgical group, but not in the group with BMI >30 kg/m.
背景/目的：本研究旨在比较预期结肠镜检查困难的患者（年轻、消瘦、肥胖个体以及既往有腹部手术或放疗史的患者）对空气、二氧化碳或水注入的耐受性。
将体重指数（BMI）小于18kg/m²或大于30kg/m²，或既往有腹部或盆腔手术史的患者在结肠镜检查期间随机分为空气注入组、二氧化碳注入组或水注入组。主要终点是在不使用镇静剂的情况下，以轻度疼痛（视觉模拟量表[VAS]评分小于5分）完成盲肠插管。
空气注入组、二氧化碳注入组和水注入组达到主要终点的病例分别为32.7%、43.8%和84.9%（P<0.001）。空气注入、二氧化碳注入和水注入时VAS的平均疼痛评分分别为5.17、4.72和3.93（P<0.001）。三组之间的盲肠插管率或操作时间无显著差异。
水注入在疼痛耐受性方面优于空气或二氧化碳注入。这在BMI<18kg/m²的亚组和术后组中可见，但在BMI>30kg/m²的组中未见。
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