Endoscopy 2007; 39(12): 1064-1067
DOI: 10.1055/s-2007-966990
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled, double-blind trial

D.  Domagk1 , M.  Bretthauer2 , P.  Lenz1 , L.  Aabakken2 , H.  Ullerich1 , C.  Maaser1 , W.  Domschke1 , T.  Kucharzik1
  • 1Department of Medicine B, University Hospital of Münster, Münster, Germany
  • 2Department of Gastroenterology, Rikshospitalet Medical Centre, Oslo, Norway
Further Information

Publication History

submitted 15 August 2007

accepted after revision 27 September 2007

Publication Date:
10 December 2007 (online)

Background and study aims: Double-balloon enteroscopy (DBE) has been proven effective for deep intubation of the small bowel. However, intubation depth is limited by distention of the small bowel due to air insufflation during the procedure. The present trial investigated whether carbon dioxide (CO2) instead of standard air insufflation would improve intubation depth during DBE, as well as reduce postprocedure pain.

Patients and methods: One hundred and twelve consecutive patients scheduled for DBE at two centers were randomly assigned to either CO2 or air insufflation during DBE. Patients and endoscopists were blinded with regard to the type of gas used. Intubation depth was registered using a validated form. Patients scored pain and discomfort during and after the examination on a 100-mm visual analog scale.

Results: One hundred patients were eligible for data analysis (48 in the CO2 group and 52 in the air group). The mean small-bowel intubation depth was extended by 30 % in the CO2 group compared to the air group (230 vs. 177 cm, P = 0.008). The superiority was most pronounced for oral DBE, with a 71-cm improvement in intubation depth when using CO2 (295 cm in the CO2 group vs. 224 cm in the air group, P < 0.001). Patient pain and discomfort were significantly reduced in the CO2 group at 1 and 3 hours after the examination.

Conclusions: CO2 insufflation significantly extended intubation depth in DBE. CO2 insufflation also reduces patient discomfort. CO2 insufflation may lead to a higher diagnostic and therapeutic yield of DBE, with reduced patient discomfort.


M. Bretthauer, MD

Department of Gastroenterology

Rikshospitalet-Radiumhospitalet Medical Centre



Email: [email protected]