Old Habits Die Hard: The Use of CO2 versus Air in Colonoscopy

Despite compelling evidence for using carbon dioxide (CO2) to reduce patient pain after colonoscopy, most endoscopists worldwide still use air insufflation during colonoscopy. A new paper aims to encourage change and new standards.

First author of the paper, prof. Michael Bretthauer, wants to encourage endoscopists to do like most endoscopists in Norway; use CO2 insufflation during colonoscopy.

The Clinical Effectiveness Group (Bretthauer, Kalager, Adami and Hoff) recently published the article Who is for CO2? Slow adoption of carbon dioxide insufflation in colonoscopy, in Annals of Internal Medicine. The authors want to encourage endoscopists to follow best practice, and use CO2 for insufflation of the colon. During colonoscopy, the colon needs to be distended in order to increase visibility and availability of lesions. Traditionally, 8-7 L of room air is used for insufflation, as compared to 1 L/day normally produced by the intestine. Room air consists of mainly nitrogen and oxygen. CO2 is absorbed 160 times faster than nitrogen, and 12 times faster than oxygen. In other words, using CO2 decreases the period of distended colon.

There is compelling evidence that CO2 decreases patient discomfort, both pain and post colonoscopy incontinence. Replacing room air with CO2 is low-cost (€1/$1.25 per colonoscopy) and will improve patient experience, as the colon stays distended for a shorter period of time. The authors encourage endoscopists world-wide to change their habit, and use CO2 rather than room air.

Annals of Internal Medicine
The article was published in Annals of Internal Medicine May 10, 2016.


– Why should we use an inferior technique when there is an inexpensive, easy-to-use option that improves patient experience? says Michael Bretthauer, first author of the paper.

By Anita Aalby/Henriette C. Jodal
Published May 25, 2016 10:17 AM - Last modified Jan. 31, 2017 1:58 PM