Original articleClinical endoscopyThe use of carbon dioxide for insufflation during GI endoscopy: a systematic review
Section snippets
Methods
Two investigators (E.S.D., J.S.H.) independently performed a search of the medical literature from 1950 through February 13, 2008, as indexed by MEDLINE by using the PubMed search engine (www.pubmed.gov). To capture all potentially relevant articles with the highest degree of sensitivity, the search terms were intentionally broad. We used “carbon dioxide and (endoscopy or colonoscopy).” Attempts to narrow the search strategy, for example, by excluding terms such as “laparoscopy” or
Search strategy
The initial search strategy yielded 2221 publications (Fig. 1). The vast majority of these (2197) were excluded because they were off topic, which was because of the intentionally broad initial search criteria. The remaining 24 publications were reviewed in full. Of these, 9 were randomized controlled clinical trials from which data were extracted (6 studied colonoscopy,3, 7, 9, 10, 11, 12 and 1 each studied flexible sigmoidoscopy,8 ERCP,4 and DBE14). Data from these trials are presented in
Discussion
GI endoscopic procedures are widely performed for diagnostic and therapeutic purposes, and visualization of the mucosa relies on insufflating gas to distend the lumen of the GI tract. In the United States, “room air” is typically used for insufflation.2, 3, 4 However, because ambient air is not well absorbed and must either be suctioned before the end of the procedure or passed from the GI tract as flatus, there is the potential for residual air to cause bowel distention and abdominal pain. CO2
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This work was funded in part by the National Institutes of Health training grant T32 DK007634.
See CME section; p 914.