Introduction Patients experience of discomfort with Air insufflation during flexible sigmoidoscopy (FS) limits compliance and thus success of the procedure. There has been only one study1 which has shown that CO2 insufflation reduces discomfort as compared to Air in FS. Recently, we have been using CO2 insufflation for routine FS. We therefore conducted a prospective audit comparing the two modalities and to assess whether the use of CO2 during FS reduces discomfort both during and after the procedure using a standardised scoring system.
Methods 200 consecutive patients undergoing FS, commonly for rectal bleeding, altered bowel habit and abdominal pain were selected to either Air or CO2 insufflation. There were 100 patients (42 males) in the CO2 group and 100 patients (5l males) in the Air group. The ages ranged from 19 to 92 years in both the groups. Any history of previous abdominal surgery was also noted. Patients were asked to grade discomfort during the procedure, post procedure in the recovery room and on discharge. We used the standardised comfort score of Wong and Baker (0==no discomfort and 10=extreme discomfort). Abdominal bloating was also assessed verbally after the procedure. Statistical analysis was done using Prism software.
Results The mean comfort scores for CO2 compared to Air during the procedure was 1.02 vs 1.93 (p=0.0006), postprocedure 0.54 vs 1.12 (p=0.002) and on discharge 0.32 vs 0.8 (p=0.0008) respectively. Abdominal bloating appeared to be less with CO2 as compared to Air on verbal questioning. No differences in comfort scores were observed with a history of previous abdominal surgery.
Conclusion This study has shown that CO2 insufflation reduces discomfort as compared to Air during FS, both during and after the procedure. Abdominal bloating was also significantly reduced. The use of CO2 will contribute to better public acceptance for FS, in particular for FS screening in colorectal cancer.
Competing interests None declared.
Reference 1. Bretthauer M, Hoff G, Thiis-Evensen, et al. CO2 insufflation reduces discomfort due to flexible sigmoidoscopy. Scan J Gastroenterol 2002;37:1103–7.
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