Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trial
Background Adequately powered studies in children are scarce and there are reports on the risk of carbon dioxide (CO2) retention after colonoscopy. Purpose This study investigated the efficacy and safety of CO2 insufflation in children undergoing colonoscopy. Methods This prospective randomized clin...
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The Korean Pediatric Society
2025-08-01
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| Series: | Clinical and Experimental Pediatrics |
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| Online Access: | http://www.e-cep.org/upload/pdf/cep-2024-02012.pdf |
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| author | Ajay Aravind Ujjal Poddar Anshu Srivastava Moinak Sen Sarma |
| author_facet | Ajay Aravind Ujjal Poddar Anshu Srivastava Moinak Sen Sarma |
| author_sort | Ajay Aravind |
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| description | Background Adequately powered studies in children are scarce and there are reports on the risk of carbon dioxide (CO2) retention after colonoscopy. Purpose This study investigated the efficacy and safety of CO2 insufflation in children undergoing colonoscopy. Methods This prospective randomized clinical trial was conducted at a tertiary care hospital between March 2023 and July 2024. We recruited 200 consecutive children (age, 5–18 years; n=100 in each arm) who underwent colonoscopy under conscious sedation. Patients were randomized to receive CO2 or room air using a random number table. The primary outcome measure was postprocedural pain assessed by using a visual analogue scale (VAS). Secondary outcome measures included time to reach the cecum, total procedure duration, abdominal distension, and end-tidal (ET) CO2 level. Complications were recorded. Results Pain scores at 2 and 4 hours postprocedure were significantly lower in the CO2 versus room-air group (1.12 vs. 1.66, P=0.001 at 2 hours and 0.37 vs. 0.61, P=0.002 at 4 hours). The time to reach the cecum was significantly higher in the CO2 group (39.6 vs. 26.6 min, P=0.01). A greater proportion of children in the room-air group (29% vs. 19%, P=0.04) reported significant pain (VAS score, ≥3). The subgroup analysis revealed a significantly longer time to reach the cecum and total procedure duration in the CO2 group among first-year trainees. ET-CO2 levels were significantly higher in the CO2 group (36 [interquartile range, 35–37] mmHg vs. 34 [interquartile range, 32–35] mmHg, P=0.001), but none developed any signs of CO2 retention. No significant intergroup differences were noted in abdominal girth, bloating sensation, analgesic requirements, or procedure-related complications. Conclusions CO2 insufflation is safer and makes the procedure less painful but slower than room-air insufflation, especially in first-year trainees, without an increased risk of retention. |
| format | Article |
| id | doaj-art-bc9080f8d40d43f7949ef84d86d21e1f |
| institution | Kabale University |
| issn | 2713-4148 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | The Korean Pediatric Society |
| record_format | Article |
| series | Clinical and Experimental Pediatrics |
| spelling | doaj-art-bc9080f8d40d43f7949ef84d86d21e1f2025-08-20T03:39:04ZengThe Korean Pediatric SocietyClinical and Experimental Pediatrics2713-41482025-08-0168859460010.3345/cep.2024.0201220125555797Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trialAjay Aravind0Ujjal Poddar1Anshu Srivastava2Moinak Sen Sarma3 Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IndiaBackground Adequately powered studies in children are scarce and there are reports on the risk of carbon dioxide (CO2) retention after colonoscopy. Purpose This study investigated the efficacy and safety of CO2 insufflation in children undergoing colonoscopy. Methods This prospective randomized clinical trial was conducted at a tertiary care hospital between March 2023 and July 2024. We recruited 200 consecutive children (age, 5–18 years; n=100 in each arm) who underwent colonoscopy under conscious sedation. Patients were randomized to receive CO2 or room air using a random number table. The primary outcome measure was postprocedural pain assessed by using a visual analogue scale (VAS). Secondary outcome measures included time to reach the cecum, total procedure duration, abdominal distension, and end-tidal (ET) CO2 level. Complications were recorded. Results Pain scores at 2 and 4 hours postprocedure were significantly lower in the CO2 versus room-air group (1.12 vs. 1.66, P=0.001 at 2 hours and 0.37 vs. 0.61, P=0.002 at 4 hours). The time to reach the cecum was significantly higher in the CO2 group (39.6 vs. 26.6 min, P=0.01). A greater proportion of children in the room-air group (29% vs. 19%, P=0.04) reported significant pain (VAS score, ≥3). The subgroup analysis revealed a significantly longer time to reach the cecum and total procedure duration in the CO2 group among first-year trainees. ET-CO2 levels were significantly higher in the CO2 group (36 [interquartile range, 35–37] mmHg vs. 34 [interquartile range, 32–35] mmHg, P=0.001), but none developed any signs of CO2 retention. No significant intergroup differences were noted in abdominal girth, bloating sensation, analgesic requirements, or procedure-related complications. Conclusions CO2 insufflation is safer and makes the procedure less painful but slower than room-air insufflation, especially in first-year trainees, without an increased risk of retention.http://www.e-cep.org/upload/pdf/cep-2024-02012.pdfpediatric colonoscopycarbon dioxideair insufflationabdominal pain |
| spellingShingle | Ajay Aravind Ujjal Poddar Anshu Srivastava Moinak Sen Sarma Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trial Clinical and Experimental Pediatrics pediatric colonoscopy carbon dioxide air insufflation abdominal pain |
| title | Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trial |
| title_full | Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trial |
| title_fullStr | Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trial |
| title_full_unstemmed | Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trial |
| title_short | Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trial |
| title_sort | efficacy and safety of carbon dioxide versus room air insufflation in pediatric colonoscopy a randomized controlled trial |
| topic | pediatric colonoscopy carbon dioxide air insufflation abdominal pain |
| url | http://www.e-cep.org/upload/pdf/cep-2024-02012.pdf |
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