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

– 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.