Chad Thornhill1, Fernando Navarro1, Baraa Alabd Alrazzak1, S Shahrukh Hashmi2, Ashish N DebRoy3, Jon M Rhoads1, Essam Imseis1. 1. Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition. 2. Department of Pediatrics, Pediatric Research Center, the University of Texas Health Science Center at Houston McGovern Medical School, Houston. 3. Pediatric Gastroenterology Associates of Houston, Webster, TX.
Abstract
GOALS: To determine if carbon dioxide (CO2) insufflation in children would improve postprocedure pain following colonoscopy in children. BACKGROUND:CO2 insufflation during colonoscopy has been found to reduce postcolonoscopy pain in the adult population, but limited data exist in pediatrics. MATERIALS AND METHODS: We conducted a prospective study with 40 pediatric patients scheduled for outpatient colonoscopy. Patients were enrolled continuously and were randomized to receive CO2 or air insufflation. Patients and colonoscopists were blinded to insufflation method. End tidal CO2 (EtCO2) was documented throughout the procedure. Abdominal pain was established preprocedure then at 1-, 6-, and 24-hour postprocedure. Subject demographics, indications, colonoscopists' year of training, time to cecum, adverse events, and final diagnoses were recorded. RESULTS:Twenty patients were randomized to each group. Patients receiving air had a statistically significant increase in pain from baseline at 1- and 6-hours after colonoscopy (P=0.007 and 0.008). This was not seen in the CO2 group (P=0.740 and 0.289). There was an increase in postprocedure pain in the air group compared with CO2 group at the 1-hour mark (P=0.032). EtCO2 increased during the procedure, regardless of insufflation method, but no difference was seen between groups (P=0.822). CONCLUSIONS: Our results demonstrate that higher levels of pain were reported by patients following air compared with those receiving CO2 insufflation. This is the first study to show CO2 is as safe as air, with no increase in EtCO2 between groups in the pediatric population. CO2 is an effective and safe modality and should be considered for pediatric colonoscopies.
RCT Entities:
GOALS: To determine if carbon dioxide (CO2) insufflation in children would improve postprocedure pain following colonoscopy in children. BACKGROUND:CO2 insufflation during colonoscopy has been found to reduce postcolonoscopy pain in the adult population, but limited data exist in pediatrics. MATERIALS AND METHODS: We conducted a prospective study with 40 pediatric patients scheduled for outpatient colonoscopy. Patients were enrolled continuously and were randomized to receive CO2 or air insufflation. Patients and colonoscopists were blinded to insufflation method. End tidal CO2 (EtCO2) was documented throughout the procedure. Abdominal pain was established preprocedure then at 1-, 6-, and 24-hour postprocedure. Subject demographics, indications, colonoscopists' year of training, time to cecum, adverse events, and final diagnoses were recorded. RESULTS: Twenty patients were randomized to each group. Patients receiving air had a statistically significant increase in pain from baseline at 1- and 6-hours after colonoscopy (P=0.007 and 0.008). This was not seen in the CO2 group (P=0.740 and 0.289). There was an increase in postprocedure pain in the air group compared with CO2 group at the 1-hour mark (P=0.032). EtCO2 increased during the procedure, regardless of insufflation method, but no difference was seen between groups (P=0.822). CONCLUSIONS: Our results demonstrate that higher levels of pain were reported by patients following air compared with those receiving CO2 insufflation. This is the first study to show CO2 is as safe as air, with no increase in EtCO2 between groups in the pediatric population. CO2 is an effective and safe modality and should be considered for pediatric colonoscopies.
Authors: John Alexander Lata Guacho; Diogo Turiani Hourneaux de Moura; Igor Braga Ribeiro; Bruna Furia Buzetti Hourneaux de Moura; Megui Marilia Mansilla Gallegos; Thomas McCarty; Ricardo Katsuya Toma; Eduardo Guimarães Hourneaux de Moura Journal: Clin Endosc Date: 2021-03-25