Colonoscopy in UC: less pain and reduced recurrence with CO2 insufflation

A Japanese study compared CO₂ with air as a means of insufflation during colonoscopies. The CO₂ cohort overall experienced less pain, and patients with baseline partial remission also suffered from fewer exacerbations of their ulcerative colitis (UC).

Patients with UC not only need to undergo colonoscopies for diagnostic indications, but for cancer screening as well. However, these procedures can also provoke disease flares. A prospective, randomised trial investigated if the use of carbon dioxide (CO₂) for intra-procedural insufflation may bear an advantage over the regularly used air insufflation in remissive UC patients (Partial Mayo Score [PMS] ≤2). The study enrolled 91 adults with a median age of 49 years; 66% were men. Overall, the baseline characteristics were evenly distributed among the 2 study groups, e.g. for disease location, Mayo Endoscopic Subscore (MES), clinical activity, and medication.

Immediately following colonoscopy, the abdominal pain score for patients in the CO₂ group was significantly lower compared with the air group, as was the score for abdominal fullness (P=0.0003 for both comparisons). At 30 minutes following procedure termination, these 2 measures were still significantly lower in patients in the CO₂ group (P<0.001 for both comparisons).

The assessment of clinical recurrence (PMS ≥3) was performed at week 1 and week 8 after the colonoscopy. At week 1, no significant disparity was observed between the groups receiving air or CO₂ for insufflation, both in patients with complete remission (MES0 or PMS0) nor those in partial remission (MES 1–3 or PMS 1/2). However, at week 8, the group of UC patients with partial remission who had been insufflated with CO₂ instead of air had a significantly lower proportion of clinical recurrence: CO₂ 0% versus air 24% (P=0.048) for MES 1–3 and 0% versus 30% (P=0.022) for PMS 1/2.

The authors summarised that CO₂ insufflation can reduce abdominal discomfort after colonoscopy and decrease clinical recurrence in those UC patients who do not have complete remission.

1. Otake Y, et al. Efficacy of carbon dioxide insufflation during colonoscopy for patients with ulcerative colitis in clinical remission- a randomised trial. Poster EP1277, Digestive Disease Week 2022, 21–24 May, San Diego, CA, USA.

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Posted on 14 June, 20228 April, 2024