Is the type of insufflation a key issue in gastro-intestinal endoscopy?

Abstract

Endoscopic procedures continue to play an emerging role in diagnosing and treating upper and lower gastrointestinal (GI) disorders. In particular, the introduction of colonoscopy in bowel cancer screening has underlined its promising role in decreasing the incidence of colorectal cancer and reducing tumour related mortality. To achieve these goals patients need to contemplate endoscopic examinations as painless and fearless procedures. 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. CO₂ is absorbed quickly through the bowel mucosa causing less luminal distension and potentially less abdominal pain. However, its exact role has not been defined completely. In particular, the beneficial use of CO₂ in upper GI endoscopy and in sedated patients is still conflicting. In the present review, we aimed to assess the current evidence for using CO₂ in endoscopy and to evaluate its potential role in the future.

Keywords: Gastrointestinal endoscopy; Colonoscopy; Endoscopic retrograde cholangiopancreatography; Insufflation gas; Carbon dioxide

Core tip: With the increasing use of gastrointestinal endoscopy, especially for screening in an asymptomatic population, increasing the tolerability of the procedure is of paramount importance. Our review summarizes evidence that carbon dioxide (CO₂) insufflation can reduce both pain and bloating in colonoscopy and endoscopic retrograde cholangiopancreatography although the evidence in gastroscopy is still lacking. Despite established safety concerns about hypercapnia, significant harm has never been demonstrated in the literature. Patients thought to be at higher risk of hypercapnia need to be included in more studies to demonstrate that CO₂ insufflation is safe in an unselected screening population but early evidence is encouraging.