Who Is for CO<sub>2</sub>? Slow Adoption of Carbon Dioxide Insufflation in Colonoscopy
Authors: Michael Bretthauer, Mette Kalager, Hans-Olov Adami, Geir Hoff
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions19 July 2016Who Is for CO2? Slow Adoption of Carbon Dioxide Insufflation in ColonoscopyMichael Bretthauer, MD, PhD, Mette Kalager, MD, PhD, Hans-Olov Adami, MD, PhD, and Geir Hoff, MD, PhDMichael Bretthauer, MD, PhDFrom Oslo University Hospital, University of Oslo, and Cancer Registry of Norway, Oslo, Norway; Harvard School of Public Health, Boston, Massachusetts; and Telemark Hospital, Skien, Norway., Mette Kalager, MD, PhDFrom Oslo University Hospital, University of Oslo, and Cancer Registry of Norway, Oslo, Norway; Harvard School of Public Health, Boston, Massachusetts; and Telemark Hospital, Skien, Norway., Hans-Olov Adami, MD, PhDFrom Oslo University Hospital, University of Oslo, and Cancer Registry of Norway, Oslo, Norway; Harvard School of Public Health, Boston, Massachusetts; and Telemark Hospital, Skien, Norway., and Geir Hoff, MD, PhDFrom Oslo University Hospital, University of Oslo, and Cancer Registry of Norway, Oslo, Norway; Harvard School of Public Health, Boston, Massachusetts; and Telemark Hospital, Skien, Norway.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0209 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 1986, English endoscopist Christopher Williams asked, "Who's for CO2?" (1), noting that using carbon dioxide (CO2) rather than room air to distend the colon during endoscopy might reduce patient pain. At the time, no high-quality evidence supported Williams' speculation, but, since 2002, several well-performed randomized trials confirmed what he had observed in his practice. Patients randomly assigned to air insufflation reported more abdominal discomfort after colonoscopy than patients randomly assigned to CO2 insufflation (2). Yet, today, most colonoscopies worldwide still use air insufflation. Why has adoption of this effective, inexpensive, "low-tech" innovation been so slow?Adequate distention of the ...References1. Williams CB. Who's for CO2? Gastrointest Endosc. 1986;32:365-7. [PMID: 3095172] CrossrefMedlineGoogle Scholar2. Wu J, Hu B. The role of carbon dioxide insufflation in colonoscopy: a systematic review and meta-analysis. Endoscopy. 2012;44:128-36. [PMID: 22271023] doi:10.1055/s-0031-1291487 CrossrefMedlineGoogle Scholar3. Yamano HO, Yoshikawa K, Kimura T, Yamamoto E, Harada E, Kudou T, et al. Carbon dioxide insufflation for colonoscopy: evaluation of gas volume, abdominal pain, examination time and transcutaneous partial CO2 pressure. J Gastroenterol. 2010;45:1235-40. [PMID: 20635100] doi:10.1007/s00535-010-0286-5 CrossrefMedlineGoogle Scholar4. Saltzman HA, Sieker HO. Intestinal response to changing gaseous environments: normobaric and hyperbaric observations. Ann N Y Acad Sci. 1968;150:31-9. [PMID: 5238613] CrossrefMedlineGoogle Scholar5. Hussein AM, Bartram CI, Williams CB. Carbon dioxide insufflation for more comfortable colonoscopy. Gastrointest Endosc. 1984;30:68-70. [PMID: 6425108] CrossrefMedlineGoogle Scholar6. Sumanac K, Zealley I, Fox BM, Rawlinson J, Salena B, Marshall JK, et al. Minimizing postcolonoscopy abdominal pain by using CO2 insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO2 delivery system. Gastrointest Endosc. 2002;56:190-4. [PMID: 12145595] CrossrefMedlineGoogle Scholar7. Maple JT, Banerjee S, Barth BA, Bhat YM, Desilets DJ, Gottlieb KT, et al; GE Technology Assessment Committee. Methods of luminal distention for colonoscopy. Gastrointest Endosc. 2013;77:519-25. [PMID: 23415258] doi:10.1016/j.gie.2012.09.025 CrossrefMedlineGoogle Scholar8. Hoff G, Moritz V, Bretthauer M, Aabakken L, Berset IP, Glomsaker T, et al. Incontinence after colonoscopy—an unrecognized and preventable problem. A cross-sectional study from the Gastronet quality assurance program. Endoscopy. 2012;44:349-53. [PMID: 22392101] doi:10.1055/s-0031-1291657 CrossrefMedlineGoogle Scholar9. Lynch I, Hayes A, Buffum MD, Conners EE. Insufflation using carbon dioxide versus room air during colonoscopy: comparison of patient comfort, recovery time, and nursing resources. Gastroenterol Nurs. 2015;38:211-7. [PMID: 25946475] doi:10.1097/SGA.0000000000000109 CrossrefMedlineGoogle Scholar10. Janssens F, Deviere J, Eisendrath P, Dumonceau JM. Carbon dioxide for gut distension during digestive endoscopy: technique and practice survey. World J Gastroenterol. 2009;15:1475-9. [PMID: 19322921] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Oslo University Hospital, University of Oslo, and Cancer Registry of Norway, Oslo, Norway; Harvard School of Public Health, Boston, Massachusetts; and Telemark Hospital, Skien, Norway.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0209.Corresponding Author: Michael Bretthauer, MD, PhD, Department of Health Management and Health Economics, University of Oslo, Forskningsveien 2b, 0318 Oslo, Norway; e-mail, michael.[email protected]uio.no.Current Author Addresses: Drs. Bretthauer, Kalager, and Adami: Department of Health Management and Health Economics, University of Oslo, Forskningsveien 2b, 0318 Oslo, Norway.Dr. Hoff: Department of Research, Telemark Hospital, Ulefossveien 10, 3710 Skien, Norway.Author Contributions: Conception and design: M. Bretthauer, M. Kalager, G. Hoff.Analysis and interpretation of the data: M. Bretthauer, M. Kalager.Drafting of the article: M. Bretthauer, M. Kalager, H.O. Adami.Critical revision of the article for important intellectual content: M. Kalager, H.O. Adami, G. Hoff.Final approval of the article: M. Bretthauer, M. Kalager, H.O. Adami, G. Hoff.Statistical expertise: M. Kalager.This article was published at www.annals.org on 10 May 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byRelief Effect of Carbon Dioxide Insufflation in Transnasal Endoscopy for Health Checks—A Prospective, Double-Blind, Case-Control TrialA meta-analysis of carbon dioxide versus room air insufflation on patient comfort and key performance indicators at colonoscopyCarbon dioxide insufflation during colonoscopy in inflammatory bowel disease patientsAnatomic Basis of ColonoscopyTarmkreftscreening med koloskopi 19 July 2016Volume 165, Issue 2Page: 145-146KeywordsAbdominal painCarbon dioxideColonColonoscopyDisclosureEndoscopyHealth economicsRandomized trialsRectumTreatment guidelines ePublished: 10 May 2016 Issue Published: 19 July 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...