| Aims At present,air insufflation in colonoscopy has remained the standard method in most centres around the world.However,there is a series of complication in conventional colonoscopy in which air is used as an insufflating agent,such as abdominal pain or bloating after colonoscopy,air embolism,even explosion et al.Recently,a modified technique of colonoscopy using carbon dioxide(CO2)as an insufflating agent has gained gradually clinical acceptance,because CO2 have some good feature,such as high absorbability,non-conbustible,difficult to form gas embolism,easy to regulate metabolism.The objective of this study were to make a simple carbon dioxide insufflator,to evaluate CO2 insufflation in colonoscopy performance and safety for animal experiment and a randomized controlled clinical trial.Methods(1)The insufflator is made of a CO2 regulator and a flow instrument.The performance and safety of CO2 insufflation in colonoscopy have been evaluated with animal experiment.Twenty hybrid dogs with an average weight of 12.5 kg were randomized to CO2 group or to air group for colonoscopy.To evluate the situation before and after the blood gas analysis,and contrast bowel distention by abdominal plain film examination.(2)Three hundred sixty patients collected from our hospital were randomized to undergo colonoscopy with insufflation of air (n=183)or CO2(n=177)by means of a the new homemade regulator. Patients with active GI bleeding and severe cardiopulmonary disease were excluded.Abdominal pain or bloating scores were recorded immediately after colonoscopy and at 1,3,6 and 24 hours by VAS,and Abdominal distention mitigation time.Meanwhile,ETCO2 were observed in four period:before exam,arrived caecum,back rectum,after exam.Residual colonic gas was evaluated on abdominal radiographs at 1hours.Results(1)The output gas pressure of homemade endoscopic CO2 regulator can reached 0.05Mpa,the flow 2.8L/min,the effect of insufflation were equal to new insufflator with air pump in endoscopic master station.(2)To assess the degree of bowl distention was slightly in the CO2 group compared with the air group at 0 minute(P＜0.01),at 5 minutes(P＜0.01),at 30 minutes(P＜0.01),at 1 hours(P＜0.01)after the procedure.There were no differences in P CO2 values in artery between the two groups before and after procedure,at the air group (P=0.414),at the CO2 group(P=0.868).(3)Three hundred fifty three patients completed the randomized controlled clinical trial. Postprocedural pain at 1,3,6 and 24 hours were significantly less in the CO2 group.93%of patients insufflated with air had colonic severe distension versus 34%for those in the CO2 group(P＜0.01).The rate of patients insufflated with air had pain at,respectively,the end,1 hours,3hours,6 hours and 24 hours(78%vs 10%,46%vs 2%,39%vs 0.5%,23%vs 0.5%,6%vs 0.5%,respectively P＜0.01)higher than the CO2 group.Abdominal distention scores in VAS were indicate that 83% patients have Varying degrees in Air group,but only 7%in CO2 group, P＜0.01.The distention mitigation time in CO2 group was Significantly less than Air group(0.82±0.51 vs 3.89±5.96hours,P＜0.01).There were no differences in ETCO2 values between the two groups before and after procedure,at the air group(P=0.881),at the CO2 group(P=0.289). Residual colonic gas in CO2 group was less than Air group by abdominal plain film examination(34%vs 93%,P＜0.01).Conclusions(1)The homemade CO2 regulator was safe and reliable,can achieved the same effect for colonoscopy gas pump,is ecpected to become a substitute product as the absence of dedicated endoscopic carbon dioxide regulator.(2)CO2 is an effective and safe gas media insufflate colonoscopy,is superior to the Air in the aspects for reducing the abdominal pain and distention after colonoscopy,and no significant impact on the arterial blood PCO2 value in the patients after colonoscopy.
|
PDF Full Text Request