A randomized controlled trial comparing water exchange and air insufflation during colonoscopy without sedation

作者：Arai Makoto^*; Okimoto Kenichiro; Ishigami Hideaki; Taida Takashi; Oyamada Arata; Minemura Shoko; Saito Keiko; Tsuboi Masaru; Maruoka Daisuke; Matsumura Tomoaki; Nakagawa Tomoo; Katsuno Tatsuro; Mitsuhashi Kanae; Nakagawa Yuki; Yamaguchi Kazuya; Yokosuka Osamu

来源：International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery, 2016, 31(6): 1217-1223.

DOI：10.1007/s00384-016-2580-z

• Colonoscopy
• Sedation
• Water exchange
• Air insufflation
• Randomized control trial

Previous studies have shown that water exchange is superior to air insufflation in attenuating insertion pain during colonoscopy. We conducted a randomized controlled trial with head-to-head comparison of these methods to assess their effectiveness in colonoscopy without sedation.
A total of 447 outpatients were randomized to either water exchange (WE) or the standard air (CO2) insufflation (AI). The primary outcome was the improvement of patient intraprocedural pain (pain score), evaluated using a questionnaire (scores 1 to 5).
After exclusion of 44 patients from further analysis, 403 patients were analyzed. There was no difference in clinical background between the WE and AI groups. Patients in the WE group reported less intraprocedural pain than those in the AI group (2.17 +/- 1.06 vs. 2.42 +/- 1.03; unpaired t test, p = 0.021). We divided the cases into two groups, more or less painful colonoscopy, based on age, body mass index, use of anti-peristaltic drugs or not, and physician's experience. In less painful colonoscopy, the WE method could reduce pain effectively but its effect was limited in the more painful group.
WE is superior to AI for attenuating insertion pain during colonoscopy without sedation, but its efficacy is limited in more painful endoscopy.

• 出版日期2016-6