| Efficacy and safety of carbon dioxide versus room-air insufflation in pediatric colonoscopy: a randomized controlled trial |
Ajay Aravind, Ujjal Poddar 
, Anshu Srivastava, Moinak Sen Sarma |
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Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India |
Correspondence:
Ujjal Poddar, Email: ujjalpoddar@hotmail.com
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Received: 27 December 2024 • Revised: 25 February 2025 • Accepted: 25 February 2025 |
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| Abstract |
Background
Adequately powered studies in children are scarce and there are reports on the risk of carbon dioxide (CO2) retention after colonoscopy.
Purpose
This study investigated the efficacy and safety of CO2 insufflation in children undergoing colonoscopy.
Methods
This prospective randomized clinical trial was conducted at a tertiary care hospital between March 2023 and July 2024. We recruited 200 consecutive children (age, 5–18 years; n=100 in each arm) who underwent colonoscopy under conscious sedation. Patients were randomized to receive CO2 or room air using a random number table. The primary outcome measure was postprocedural pain assessed by using a visual analog scale. Secondary outcome measures included time to reach the cecum, total procedure duration, abdominal distension, and end-tidal CO2 level. Complications were recorded.
Results
Pain scores at 2 and 4 h post-procedure were significantly lower in the CO2 versus room-air group (1.12 vs. 1.66, p=0.001 at 2 h and 0.37 vs. 0.61, p=0.002 at 4 h). The time to reach the cecum was significantly higher in the CO2 group (39.6 vs. 26.6 min, p=0.01). A greater proportion of children in the room-air group (29% vs. 19%, p=0.04) reported significant pain (visual analog scale score, ≥3). The subgroup analysis revealed a significantly longer time to reach the cecum and total procedure duration in the CO2 group among first-year trainees. End-tidal CO2 levels were significantly higher in the CO2 group (36 [interquartile range, 35–37] mmHg vs. 34 [interquartile range, 32–35] mmHg, p=0.001), but none developed any signs of CO2 retention. No significant intergroup differences were noted in abdominal girth, bloating sensation, analgesic requirements, or procedure-related complications.
Conclusions
CO2 insufflation is safer and makes the procedure less painful but slower than room-air insufflation, especially in first-year trainees, without an increased risk of retention.
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| Key Words:
Pediatric colonoscopy, Carbon dioxide, Air insufflation, Abdominal pain |
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