Does carbon dioxide insufflation impact adenoma detection rate? A single-center retrospective analysis

Background and study aims: Carbon dioxide (CO₂) has been associated with reduced post-procedural pain and improved patient satisfaction when compared to air insufflation (AI). The effect of CO₂ insufflation (CO₂I) on the adenoma detection rate (ADR) remains unclear. The aims of this study are to compare ADR in patients undergoing screening colonoscopy with AI vs. CO₂I and identify predictors of ADR.

Patients and methods: Single-center retrospective cohort study of 2,107 patients undergoing screening colonoscopy at the University of Florida Hospital between November 2011 and June 2015. Patient demographics, procedural parameters, and histology results were retrospectively obtained from a prospectively maintained colonoscopy database. Univariate and multivariate analysis were performed to identify predictors of ADR.

Results: A total of 2107 colonoscopies (644 with AI and 1463 with CO₂I) were analyzed. Overall ADR was 27.8 %. There was no significant difference in ADR between AI (27.6 %) vs. CO₂I (27.8 %) (P = 0.93). Method of insufflation (AI vs. CO₂I) was not significantly associated with ADR (OR 0.9; 95 % CI:0.7 – 1.2). Older age (OR: 1.02; 95 % CI: 1.001 – 1.03 per year increase), male gender (OR 1.48; 95 % CI: 1.17 – 1.87), and longer scope withdraw time (OR 1.13; 95 % CI: 1.1 – 1.16 per minute) were associated with a higher ADR. Fellow involvement was negatively associated with ADR (OR 0.60; 95 % CI: 0.47 – 0.77).

Conclusion: ADR was similar between patients who underwent screening colonoscopy with AI vs. CO₂I. While CO₂I has been associated with improved patient comfort and post-procedural recovery time, there is no definitive evidence to suggest that this method of luminal distention enhances ADR.

• References

• 1 Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 2 Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin 2014; 64: 104-117
• 3 Pohl H, Robertson DJ. Colorectal cancers detected after colonoscopy frequently result from missed lesions. Clin Gastroenterol Hepatol 2010; 8: 858-864
• 4 Kaminski MF, Regula J, Kraszewska E et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
• 5 Rex DK, Schoenfeld PS, Cohen J et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
• 6 Corley DA, Jensen CD, Marks AR et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
• 7 Wu J, Hu B. The role of carbon dioxide insufflation in colonoscopy: a systematic review and meta-analysis. Endoscopy 2012; 44: 128-136
• 8 Brandt LJ, Boley SJ, Sammartano R. Carbon dioxide and room air insufflation of the colon. Effects on colonic blood flow and intraluminal pressure in the dog. Gastrointest Endosc 1986; 32: 324-329
• 9 Yasumasa K, Nakajima K, Endo S et al. Carbon dioxide insufflation attenuates parietal blood flow obstruction in distended colon: potential advantages of carbon dioxide insufflated colonoscopy. Surg Endosc 2006; 20: 587-594
• 10 Sumanac K, Zealley I, Fox BM et al. Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc 2002; 56: 190-194
• 11 Aronchick CA, Lipshutz WH, Wright SH et al. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc 2000; 52: 346-352
• 12 Schlemper RJ, Riddell RH, Kato Y et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
• 13 Cotton PB, Eisen GM, Aabakken L et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 14 Hafner S, Zolk K, Radaelli F et al. Water infusion versus air insufflation for colonoscopy. Cochrane Database Syst Rev 2015; 5: Cd009863
• 15 Leung FW, Amato A, Ell C et al. Water-aided colonoscopy: a systematic review. Gastrointest Endosc 2012; 76: 657-666
• 16 Mills CD, Swaine A, Mccamley C et al. Su1686 The impact of carbon dioxide insufflation on colonic polyp and adenoma detection rate. Gastrointestinal Endoscopy 2015; 81
• 17 Riss S, Akan B, Mikola B et al. CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: a randomized controlled trial. Wien Klin Wochenschr 2009; 121: 464-468
• 18 Wang WL, Wu ZH, Sun Q et al. Meta-analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy. Aliment Pharmacol Ther 2012; 35: 1145-1154
• 19 Schramm C, Mbaya N, Franklin J et al. Patient- and procedure-related factors affecting proximal and distal detection rates for polyps and adenomas: results from 1603 screening colonoscopies. Int J Colorectal Dis 2015; 30: 1715-1722
• 20 Cai B, Liu Z, Xu Y et al. Adenoma detection rate in 41,010 patients from Southwest China. Oncol Lett 2015; 9: 2073-2077
• 21 Barclay RL, Vicari JJ, Doughty AS et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006; 355: 2533-2541
• 22 Jover R, Zapater P, Polania E et al. Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies. Gastrointest Endosc 2013; 77: 381-389.e381
• 23 Butterly L, Robinson CM, Anderson JC et al. Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire Colonoscopy Registry. Am J Gastroenterol 2014; 109: 417-426
• 24 Buchner AM, Shahid MW, Heckman MG et al. Trainee participation is associated with increased small adenoma detection. Gastrointest Endosc 2011; 73: 1223-1231
• 25 Leffler DA, Kheraj R, Bhansali A et al. Adenoma detection rates vary minimally with time of day and case rank: a prospective study of 2139 first screening colonoscopies. Gastrointest Endosc 2012; 75: 554-560
• 26 Burke CA, Choure AG, Sanaka MR et al. A comparison of high-definition versus conventional colonoscopes for polyp detection. Dig Dis Sci 2010; 55: 1716-1720
• 27 Tribonias G, Theodoropoulou A, Konstantinidis K et al. Comparison of standard vs high-definition, wide-angle colonoscopy for polyp detection: a randomized controlled trial. Colorectal Dis 2010; Oct 12: e260-266
• 28 East JE, Stavrindis M, Thomas-Gibson S et al. A comparative study of standard vs. high definition colonoscopy for adenoma and hyperplastic polyp detection with optimized withdrawal technique. Aliment Pharmacol Ther 2008; 28: 768-776